NEW TREATMENT FOR PLAN QUALITY

TAMPA, Fla. -- While most employer coalitions are giving their health plans report cards, one group of employers is trying a disease-specific approach to measure the quality of health care in its community.

Rather than asking employees, "How do you like your health plan?" the Healthy People/Productive Community Survey asked: "What diseases do you have?" and, "How would you rate the quality of the treatment you've been receiving for them?" explained Frank Brocato, president and chief executive officer of the Tampa, Fla.-based Employers Health Coalition.

The findings will be used to develop best-practice guidelines for health plans as well as to improve existing disease management and return-to-work programs, Mr. Brocato said.

"We can actually break it down by plan and look at it and say, 'This one plan scored very high and does not seem to have the problems that the other two plans have,' " so that "we can find out what somebody is doing better and pass it on" to other plans, Mr. Brocato said.

Employers also can compare the survey findings with their own claims data, which often overlooks secondary medical conditions triggered by primary illnesses, Mr. Brocato explained.

For example, an employer might identify from claims data breast cancer or heart surgery, but "the employer doesn't see the ongoing depression or hypertension that the patient is going through," he pointed out.

By identifying such secondary disorders and the burden they place on patients' lives, providers can treat patients on a more holistic basis, thus improving the overall quality of health care, he suggested.

Survey respondents reported an average of 2.15 diseases per household.

The survey is the third phase of a continuing quality improvement effort by the coalition, which has been collecting claims data since its formation in 1984. It collected clinical outcomes data between 1992 and 1997. After completing a three-year trend analysis last year, "we formed an oversight committee to determine where we wanted to go from here," Mr. Brocato recounted.

At first, the coalition considered doing report cards, "but we said, 'NCQA is doing that.'. . .What we really wanted to know was what the population thinks," he said. Furthermore, "we need to have them look at what they consider to be the impact or the burden of the disease in both the workplace and the home," he added.

The survey findings were released at a recent press conference in Tampa and later presented at the National Business Coalition on Health meeting last week in Nashville, Tenn. The results will be outlined again at the National Managed Health Care Congress workshop Oct. 27-28 in Atlanta.

The survey was conducted by mail, sent to the homes of 20,000 employees of eight area employers that represent small, medium and large organizations in both the public and private sector. Participating employers included Cargill Fertilizer, Florida Blood Services, GTE, Honeywell Space Systems, Pasco County government, Pasco County schools, Pinellas County government and TECO Energy. The coalition, with eight employees, participated as the small employer in the survey.

The survey, administered by the University of Iowa, was conducted in two waves. First, a general survey that focused on 31 health conditions asked questions pertaining to general health and wellness; return-to-work status; and productivity, both at home and work; as well as patients' satisfaction with physicians, health plans and benefit programs. First-wave respondents also were asked to list what disorders they had of the 31 listed.

A second survey was sent to the homes of employees who reported that either they or someone in their household had one or more of the top 10 disorders from the list of 31 conditions.

The response rate for the first wave of the survey was 32%. Of the 6,215 people who responded, 4,707 reported that they or someone in their household had one or more of the top 10 conditions. The remainder reported not having any of the top 10 conditions.

The second wave of the survey was sent to the 4,707 who responded positively to the first survey. Of those, 40% responded to the second survey.

So far, only the first-wave survey results have been made public. The second-wave results will be released next month.

The most prevalent conditions reported of the top 10 were allergies, 28%; hypertension, 16%; and depression, 9%. Among the other 21 conditions, the most prevalent were arthritis, 21%; neck/back/spine problems, 20%; migraine, 13%; and sciatica and back problems, 13%.

When respondents suffering from the top 10 conditions were asked to rate the quality of the overall health care process, those who had breast cancer rated it the highest, while those with hepatitis, depression and diabetes rated it the lowest. Mr. Brocato attributed the positive response of breast cancer patients to the large amount of attention and education the disease has been getting in recent years.

By contrast, those suffering from less-publicized diseases reported less satisfaction with care, he pointed out. For example, those suffering from hepatitis criticized access, management of care and coverage; and those with depression reported the least favorable outcomes, quality, communication, plan administration, and overall plan satisfaction, and they were the least willing to recommend their plan to others. Those with diabetes rated customer service low.

The survey also asked employees to rate the "burden" their health conditions created, both in their personal lives and in their social and/or work lives.

"For example, heart problems and breast cancer were two of the top 10 that seemed to impose the greatest burden on the individual, but when you look across the entire strata of the population, hypertension seemed to be a greater burden" on their community life, including family and coworkers, Mr. Brocato explained.

Participants identified depression and allergies as two of the top 10 disease disorders that had the greatest impact on their work lives, while depression and heart problems had the greatest impact on their personal lives, he said.

When all 31 conditions were taken into consideration, loss of motion, sciatica/back and neck/back/spine had the greatest burden both at work and at home.

For the most part, benefit managers and health care consultants praised the coalition's disease-specific approach to measuring health care quality in the community.

"This will affect systemically the practice in the marketplace by providers and how health plans support consumers, so that there will be a much broader impact than just for these employers. They are to be commended for the initiative they've taken," observed Suzanne Mercure, formerly the benefits manager for Rosemead, Calif.-based Edison International and now a principal at Barrington & Chappell, a health care consulting firm in Falls Church, Va.

"A lot of the coalition work (usually) looks at financial indicators or proxies for quality of care, but they don't get right down to this detail of a needs assessment," observed Camille Haltom, a health care consultant with Hewitt Associates L.L.C. in Lincolnshire, Ill. "So it is kind of exciting that they're making some links between chronic conditions and co-morbid conditions."

"This is an excellent start. The Tampa employers are to be commended for taking the initiative," said Robert Brown, president of the Mid-American Coalition on Health Care in Kansas City, Mo. "The Tampa experience shows that we're turning a corner and trying to start making a difference and not just talking about cost."

But Ray Brusca, vp-benefits at Black & Decker Corp. and a member of the Washington Business Group on Health's board of directors, doubted the coalition's effort will have much impact on improving the quality of health care on a communitywide basis.

"It's an interesting survey, but given the small number of participants and the size of the Tampa area, I question whether the organization will be able to achieve any demonstrable changes in health outcomes in the community as a whole," he said.