PACIFICARE PUBLICIZES GRADES IT GIVES MEDICAL PROVIDERS

CYPRESS, Calif. -- A California health maintenance organization is making public for the first time information on the performance of the medical groups with which it contracts.

While most HMOs keep tabs on their medical groups, the information they collect usually is kept confidential from plan participants.

Other so-called report cards released to date have either focused solely on member satisfaction or on clinical outcomes, such as the National Committee for Quality Assurance's HEDIS program, which employers often use to compare health plans.

But PacifiCare of California's Quality Index measures medical group and independent practice association performance in three categories:

* Administrative, which covers the quality of professional and institutional patient encounter data.

* Clinical, which encompasses the frequency and quality of preventive and chronic disease treatment.

* Service, which includes patient satisfaction, member transfer and disenrollment rates and member complaints.

PacifiCare's Quality Index was made available to consumers and employer groups last week. In addition, "best practice" designations will be included in PacifiCare's provider directory, which is updated three times a year.

Fred Steinmetz, chief of the Health Benefit Services Division for the Sacramento, Calif.-based California Public Employees Retirement System, the state's largest health care purchaser, applauded the move.

"This is exactly the kind of information that our members have been asking for. We have been providing input to PacifiCare from the employer perspective and believe the Quality Index will give our members an information tool that will enable them to make informed decisions and ensure that they are receiving quality health care," he said.

Bruce Noda, a principal at benefit consultant William M. Mercer Inc. in San Francisco, observed: "Patients will be very interested in how their doctors score. They'll either use the information to pressure them to do better or they'll use their feet to give them a message. Doctors need to realize that their patients are also their clients."

Suzanne Mercure, the former health insurance programs manager for Rosemead, Calif.-based Edison International, also applauded PacifiCare's move.

"It's almost like we've moved from focusing on health care to focusing on health service and information because we're enabling the consumer to maintain his or her own health status," said Ms. Mercure, who had participated in a focus group to which PacifiCare introduced the initiative two years ago.

"PacifiCare went to the Edison Retirees Consumer Committee to get their opinions, and what they found was that there was a great deal of consumer interest in this level of data," recounted Ms. Mercure, now a principal in Falls Church, Va., with the health care consulting firm Barrington & Chappell.

The scope of PacifiCare's Quality Index is greater than other quality initiatives launched to date nationwide, acknowledged industry observers.

"Our own quality measures are moving down to that level, but for now it's still at the plan level," said a spokesman for the Washington-based NCQA.

For example, NCQA's recently launched Physician Organization Certification Program reviews medical groups so that managed care organizations seeking accreditation know ahead of time which are likely to meet the NCQA's criteria, the spokesman explained.

Woodland Hills, Calif.-based Blue Cross of California has collected information on provider performance like that which PacifiCare is publishing, but that information is never made public; rather, it is used to coach plan physicians, a spokeswoman said. On occasion, the information is released to employers who request it but it never is released to individual plan participants.

Health Net, also in Woodland Hills and the HMO subsidiary of Foundation Health Systems Inc. last March published a member satisfaction survey on medical groups that didn't include any clinical outcomes data.

So far, the only initiative that has come close to that of PacifiCare was one instituted two years ago by the Pacific Business Group on Health, a 34-member employer coalition based in San Francisco.

Last year the PBGH published a report comparing medical groups based on a random survey covering patient satisfaction, perceptions of quality, whether certain preventive services were administered, and whether patients with high blood pressure or cholesterol were referred for treatment (BI, Sept. 22, 1997).

"We surveyed patients and medical groups in 1996 and put the results on our Web site last year," said Cheryl Damberg, director of research and quality for the PBGH.

But even though many components of the PBGH's survey are similar to PacifiCare's, "there are some differences," she acknowledged.

Among them: "We didn't include complaints or transfers or congestive heart failure admissions," she said.

By contrast, PacifiCare did include such information in what it is providing participants.

While PacifiCare may not have had the original idea to publish such data, Ms. Damberg said the HMO still should receive credit for doing it.

"I do think PacifiCare is doing something that we've been encouraging," she said. Arming health care consumers with relevant information will, hopefully, "steer patients to medical groups who are good performers. This is a step in the right direction."

Dr. Sam Ho, corporate medical director for PacifiCare Health Systems Inc., the HMO's parent company, said, "The Quality Index is the logical evolution of the market research and consumer focus groups that we've been doing for years."

"We're trying to provide credible and relevant information to consumers and at the same time raise the level of accountability of providers to improve their performance," he said.

In fact, PacifiCare, which gathered the information continuously over the past 12 months, shared the findings with the medical groups along the way to give them a chance to improve their scores before the information was released to the public, according to Dr. Ho.

This is not the first time PacifiCare has employed an innovative strategy as it competes for a larger share of the health care market.

Last year the HMO agreed to tie a share of its senior executives' compensation to an employer group's satisfaction.

In an agreement with CalPERS that also capped rate hikes for 1998 through the year 2000, 10% of the bonus paid to as many as eight of PacifiCare's top executives will be withheld unless at least 80% of CalPERS members enrolled in the plan say they are satisfied with the HMO and its contracting physicians (BI, April 21, 1997).

While the two initiatives are unrelated, there is a connection, pointed out PacifiCare's Dr. Ho. "Health plan satisfaction is, in large part, affected by member satisfaction at the provider level," he said.