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SEATTLE-The managed care industry is entering a new era of accountability when increasing numbers of employers will use the latest generation of standardized quality measures to decide which plans to bring to the negotiating table and which to ultimately select.
That conclusion was reached by three speakers at last week's American Assn. of Health Plans annual conference in Seattle, though each presented a different perspective on why the industry will turn to the third version of the Health Plan Employer Data & Information Set for guidance.
HEDIS, a collection of standardized performance measures intended to allow the comparison of one health plan to the next, is being marketed by the Washington-based National Committee for Quality Assurance, a non-profit research organization.
The new version of HEDIS aims to give buyers and consumers more information on managed care plans by including a broader scope of performance measures and setting up a process for introducing new measures, as needed, into the next century.
The sole employer in the panel discussion, Thomas J. Davies of Stamford, Conn.-based GTE Corp., said incorporating HEDIS data into employees' selection of medical coverage will allow them to choose the best value for their money. GTE gives financial incentives to those employees who make cost-efficient choices within a range of managed care options.
Mr. Davies, who is manager of GTE's 13-state West managed care region, said in the past five years his company has increased the proportion of employees in health maintenance organizations to two-thirds from one-third.
"We discovered about five years ago, or a little longer than that, that we could no longer from a business point of view tolerate the out-of-control escalating health care costs. Our goal is to move folks up this continuum, toward higher levels and opportunities for care management and cost effectiveness (in HMOs)," he said.
To do that, he said, HEDIS data will be essential to act as a beacon to better health care values.
HEDIS data are powerful for three purposes, Mr. Davies said: to empower consumers to differentiate among health care plans; to help HMOs improve themselves by showing them their own weak spots; and to help payers design a financial incentive and reward program with true backbone.
"The question always comes up for employers: 'Why are you asking about quality? We know you're just in it for the money.' And the last part really is true. We are in it for the money. But we're very much aware that in our competitive arena quality costs less," he said.
The emphasis that HEDIS places on quality, as opposed to cost, will be welcomed by buyers if employers look at the large picture and not next year's bottom line, he said, praising the Ford Motor Co. slogan "Quality is Job One."
"This is especially true in medicine, and we've known it a long time,' Mr. Davies said.
GTE collects and publishes HEDIS data in five categories: surgical/medical quality; women's health; satisfaction; access; and preventive services. Plans are given one to three diamonds in each category to aid workers in choosing their network. In addition, GTE has used HEDIS periodically as an educational tool by bringing together representatives from health plans in a region and displaying one another's performance ratings.
Such an effort has gone on between GTE and plans in Portland, Ore., in the past two to three years, with an outcomes study on breast cancer treatment supplying the market with data on each HMO's quality. The report was released in May.
HEDIS data can be particularly valuable for use by HMOs for self-diagnostic purposes, said Dr. George Isham, medical director and chief health officer of HealthPartners Inc. in Minneapolis.
"In addition to measurements for accountability and external performance, we can think about measurement in terms of internal usage-the use of measurement for quality improvement," he said.
But Dr. Isham, who is co-chair of the NCQA committee that developed the HEDIS 3.0 measurements, cautioned that there will be hurdles in the successful use of HEDIS measurements in the buyers' marketplace.
"There are tremendous gaps in our ability to measure," he said.
The need also exists to measure quality and outcomes for traditional fee-for-service medicine in addition to managed care, as well as ways to determine just what employers should do with the data after it is obtained. '
An unusual perspective on HEDIS importance came from the third member of the panel, Rep. Lee Greenfield, a state representative from Minnesota who has been instrumental in health care reform there and generally supportive of managed care.
Data must be collected to prove that managed care plans are doing an effective job, he argued, or state legislatures will continue to attempt to regulate them. Outcome measures are the way for HMOs to keep hold of their own destiny.
And even with data, lawmakers sometimes will ignore facts on outcomes, he warned.
"It is the case that no matter how much data you have, one anecdote will wreck it all," he said. "If somebody can talk about somebody's mother in (Minnesota), I don't know how much data you have to show that that's an anomaly."
As for NCQA's managed care accreditation program, which at present is separate from the HEDIS program, Mr. Greenfield was blunt and said he saw little value for consumers.
"Having NCQA accreditation is of about zero interest to the general public," he said. "Nobody cares out there other than members of your own organizations."
Mr. Davis of GTE responded: "For us it (accreditation) is a threshold requirement. . . .We only select from among those plans that have stood for accreditation, and we think those that have tried and failed are a darned sight better than those that decide not even to apply."