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EASING HMO COMPARISONS

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PORTLAND, Ore.-A new tool designed to enable the average employee to compare health maintenance organizations with ease has been proposed by the Foundation for Accountability, a consumer advocacy group.

The foundation's new "communication framework," formally approved by the group's board of directors in September, is intended to come to the consumer's rescue by simplifying huge amounts of HMO-related data that are expected to be flowing from many organizations in the near future. The framework organizes and sorts the data so a plan sponsor can present unified information to workers, said Christina Bethell, director of research for FACCT in Portland, Ore.

Corporate benefit managers have an enormous amount of information relating to the comparable quality of health plans and need "a way to talk to consumers" so that this information makes sense, said Ms. Bethell. This new way of sorting data is different from report cards, which have been used to sum up the quality of health plans with simple letter grades.

The framework, when used by employers or other groups, will help make the evaluation of HMOs more meaningful, said Alan Peres, manager of health care policy for Ameritech Corp. in Chicago and a member of the FACCT board. FACCT expects members of large associations, such as the American Assn. of Retired Persons, the National Alliance for the Mentally Ill and state agencies to begin using the framework within a year, and it is to be used by the U.S. Health Care Financing Administration in the evaluation of Medicare risk HMOs next year.

Under the Balanced Budged Act of 1997, HCFA is required to provide comparisons of HMO quality to Medicare recipients by fall 1988. HCFA gave FACCT a $150,000 grant for the development of a framework.

The development of a framework was a "simple but very important step" toward supplying employees with information they sorely need, said Ellyn Spragins, author of an upcoming book, "Choosing and Using an HMO," and a researcher who has worked with FACCT to rank HMOs in the past.

Employees will be able to use the framework to pinpoint what kind of insurance will meet their needs in the next three to five years, she said.

FACCT's framework sorts data into five broad categories:

The Basics: Access, skill, communication, coordination of care and follow-up.

Staying Healthy: Helping people stay healthy.

Getting Better: Helping people heal.

Living with Illness: Helping the chronically ill.

Changing Needs: Helping people when their health changes dramatically.

Information that can be fed into the FACCT mechanism includes Health Plan Employer Data & Information Set, or HEDIS, data from the National Committee for Quality Assurance, data from the Joint Commission on Accreditation of Health Care Organizations, and FACCT's own data sets.

The framework will help companies "make sense out of all the different statistics that are suddenly being dumped in benefit managers' laps," said Jon Newpol, a director in the national practice of the Medstat Group, based in Atlanta.

"I think that's great," Mr. Newpol said. "It will help people understand the big picture a little better."

The framework also addresses the problem of duplicity in data, Mr. Newpol said. Differing statistics on the same topics now are available from many different sources, leading many benefit managers to yearn for fewer and not more sources of information.

"People are longing for this (unity of) information," he said. "This is a long-overdue process."

FACCT officials did not know how much it would cost a company to license the HMO framework.

FACCT is a not-for-profit agency that creates measurement sets for use by other agencies and companies. Last year it endorsed measurement sets for asthma, breast cancer, diabetes, major depression, health risks, health status of people over 65, health status of people under 65 and consumer satisfaction. It is currently creating measures for alcohol abuse, coronary artery disease, HIV infection/AIDS and care at the end of life.