A coalition of HMOs and employers is moving ahead with plans to develop a managed-care quality "report card" for use by New England consumers as early as September.
It's the latest in a series of efforts by providers and payers to test the best methods for reporting how well HMOs deliver care. HMOs have been hampered by their inability to prove they deliver care that's superior to fee-for-service medicine.
The New England group, which is being led by Maynard, Mass.-based Digital Equipment Corp. and Harvard Community Health Plan, Brookline, Mass., is developing community-based health information data based on the Health Plan Employer Data and Information Set, or HEDIS, said Stephan S. Rodgers, director of HMO management services for John Hancock Mutual Life Insurance Co., Boston, another member of the coalition. The group's members have total annual healthcare expenditures of $4.5 billion for 3 million workers and their dependents.
Mr. Rodgers said the group is using the HEDIS categories because "it's the first document that's specific enough to bring health plans to the table" for comparison.
He said the group, which includes 16 health plans and 28 employers, is sharing its work with the National Committee for Quality Assurance, Washington. NCQA is supervising a national report card project involving 21 HMOs that's intended to develop uniform standards of performance. Some 9.6 million enrollees are involved in that project (Jan. 10, p. 41).
Digital and two other coalition members, Bull Information Systems and GTE, began working in 1988 to create a standardized method to collect data in a partnership with several major New England HMOs, including Harvard, Fallon Community Health Plan and Tufts Associated Health Plan. Their work culminated in HEDIS, which was adopted and refined by various NCQA subcommittees last year. Another report card project by United HealthCare and Cigna HealthCare has come under fire from rival HMOs because they fear it may not be based on comparable data (April 4, p. 44).
Mr. Rodgers said the New England group wants to find variations in the way plans are reporting the data and figure out how to make them comparable. The group will then share its findings with NCQA, he said.
The New England project is far less costly-participating HMOs each must contribute only $5,000, compared with $100,000 for participants in NCQA's national program-but the work is extremely time-consuming, said an executive of a participating HMO.
Even so, the HMOs have little choice if they want to continue to do business with Digital and other New England payers, he said.
Mr. Rodgers said his group's goal is to collect the data for final review by mid-May. A format for the report card will then be chosen. The report will be published by the end of September.