Managed-care industry leader United HealthCare Corp. is fast becoming a maverick as many health plans seek ways to prove to employer groups that they're providing top-quality care.
Last month, United persuaded Cigna HealthCare to join in a report card project that will cover more than 4 million enrollees in some 40 cities.
Earlier this year, United declined to join 21 of the nation's largest health plans in a year-long project to develop a standard quality report card for use by 9.6 million enrollees (Feb. 14, p. 12).
Last year, Minnetonka, Minn.-based United jolted the industry when it announced a unilateral project billed as the nation's "first report card on healthcare" at a press conference in Washington. United operates health maintenance organizations in 13 states covering 1.6 million enrollees.
Philadelphia-based Cigna said it will pay about $3 million to United in the next two years to produce the report cards. Cigna said United would develop baseline health plan quality-management reports as well as reports based on the Health Plan Employer Data and Information Set, or HEDIS, which is intended to assess the overall quality and utilization of health plans, focusing on outpatient care and preventative measures.
The insurer said it chose United because the HMO can produce the reports more quickly and less expensively than it could itself. A Cigna spokesman said it intends to publish the report cards as a service to its clients.
Although United has the reputation for operating a top-notch data system, some healthcare executives questioned whether the move by United and Cigna ultimately would damage efforts by the managed-care industry to establish uniform standards of measurement.
It's important that "everybody plays by the same rules," said Gene Beed, M.D., associate vice president for medical affairs at FHP, a Fountain Valley, Calif.-based managed-care company.
"It's almost a divisive approach to the process of measuring quality of care," said Antonio P. Legorreta, M.D., medical director of USQA, a subsidiary of U.S. Healthcare, Blue Bell, Pa. In January FHP, U.S. Healthcare and Cigna's Northern California HMO were among the 21 HMOs that launched the national report card project to test a standard method of identifying, calculating and reporting 60 performance measures covering quality, enrollee satisfaction, utilization and financial data. Reports comparing the plans will be published at year-end.
The HMOs agreed to use HEDIS criteria established by the National Committee for Quality Assurance, a Washington-based HMO accreditation agency. HEDIS has the support of the Managed Health Care Association, a Washington-based education, research and lobbying group representing 110 private employers nationwide.
Several dozen of MHCA's members already require their health plans to use HEDIS standards in all their quality reports, and many more payers are expected to do the same.