A federal healthcare research agency plans to develop a national report card on managed-care providers that will rely on consumer surveys and reviews of medical records to gauge quality.
The Public Health Service's Agency for Health Care Policy and Research intends to work with a coalition of industry groups and health plans to develop the report card, said Clifton Gaus, the agency's administrator.
The initial focus of the effort will be on a consumer satisfaction survey of managed-care plans, which should be completed in a year or two. Mr. Gaus said the agency will review medical records and insurance claims data as part of a more technical quality report, which probably will not be completed for three to four years.
The agency is about to award a six-month contract to design the consumer survey, which will seek opinions on such issues as access to and satisfaction with care, and reasons for disenrollment in health plans.
Agency officials were unable to provide an estimate on the cost to develop the national report card because of negotiations with contractors and the number of funding sources. The agency has a $170 million budget.
Mr. Gaus said the report card aims to reverse some public anxieties that the managed-care industry focuses too much on cost and not enough on the quality of care.
"We think, in the long run, that like the auto industry, which learned over time that price alone isn't the only reason people buy a car, quality certainly plays a role in healthcare," Mr. Gaus said.
Provider and managed-care groups generally supported the concept of report cards, although they weren't fully aware of the agency's plans.
"I think there's a need for an industrywide standard, and we anticipate that they're going to be working with not just HMOs, but the entire healthcare industry," said Jon Gabel, director of research for the Group Health Association of America.
But Mr. Gabel said he hadn't been told the agency intends to do more than a consumer satisfaction survey.
William Erwin, an American Hospital Association spokesman, said the group supports private and public efforts to improve public accountability and disclosure, and will evaluate government and industry initiatives.
The agency effort parallels some private-sector attempts to develop disclosure programs. The Joint Commission on Accreditation of Healthcare Organizations expects in November to begin releasing performance reports on the healthcare organizations it accredits.
The National Committee for Quality Assurance also is working on a consumer-oriented report card pilot project with 21 health plans.
That report card builds on the committee's Health Plan Employer Data and Information Set, or HEDIS. A group of HMOs and employers first developed and released HEDIS data in 1991 to guide employers when they contracted with managed-care plans. NCQA now has released a second version that uses 1993 data.
Health plans voluntarily seek the JCAHO and NCQA report cards to help assure employers of the quality of their services.