There they are, plain as day, one health plan after another on the page. Next to their names, in easily comparable columns, are their scores on surgeries, screenings and satisfaction.
In market after market, measures of performance once toted up in obscurity by HMOs for their employer customers are now being made public in a bigger way than ever before.
In the latest example, audited scores from seven Dallas-area health plans on 23 measures of quality, access to care and use of services were released last month by a local group called the North Central Texas HEDIS Coalition. The group explained the numbers to media, business and consumer organizations during a daylong meeting, and received coverage by the local ABC-TV affiliate.
Last fall, a St. Louis-based publication called Health Pages gave consumers in the Los Angeles area a sampling of information about 11 area HMOs from polls taken by the publication and by the Pacific Business Group on Health.
Similar projects hit the streets of Pittsburgh and Denver in conjunction with the National Committee for Quality Assurance, which is refining the comparability of a 60-measure menu called the Health Plan Employer Data and Information Set, or HEDIS.
The NCQA and a stable of allies with varying motivations have begun in earnest to put these measures to the test and then report the results in a form that regular people can flip through or summon onto a computer screen.
Although health plans have been releasing their HEDIS information for a few years, it's been up to consumers to judge whether the scores are credible and to compare results between competitors. The new push emphasizes cooperation among competing health plans to issue results on identical measures and have the NCQA independently validate the results.
This proliferation of side-by-side comparisons is becoming plausible through the nearly universal acceptance of HEDIS as a reporting standard.
About 300 HMOs and other health plans use the set of measures to report on their performance, and the standardization of data collection has occupied the NCQA's attention as the key to making information on each measure truly comparable.
The Report Card Pilot Project, released by the NCQA in February 1995, was a national initiative to test the ability to standardize data enough to make them comparable from plan to plan.
But while the final report gave summary results of all 21 participating plans, it disappointed those who were anticipating "report cards" with item-by-item comparisons. "The national project couldn't compare plans because they weren't local competitors," said Martin Schneider, publisher and editor of Health Pages.
The next step is to home in on specific markets and the competitors that serve them so they can be compared, Schneider said.
"These local report cards deliver on the promise of NCQA's national pilot project," said NCQA President Margaret O'Kane. "They respond to the needs of consumers and purchasers for good comparative information on health plan quality."
In Dallas, Denver and Pittsburgh, health plan participation was voluntary, although those that didn't participate were noted in the resulting report. Health plans also had their results audited for accuracy by the NCQA.
Results varied. In Denver, for example, the percentage of targeted women given mammogram screenings ranged from 64% to 84%, though all registered above the national goal of 60% set by the U.S. Public Health Service. The rate of angioplasties among plans, however, showed a 30-fold difference, from less than 1 to more than 12 per 1,000 men age 45 to 64.
Performance levels of HMOs crossed paths with hospitals in the reporting format of Health Pages, which listed the hospital affiliations of each plan.
The checklist showed some selective contracting among the nine plans and 24 hospitals charted in Denver. In Los Angeles, however, the 11 participating HMO companies listed nearly blanket affiliations with the 37 hospitals represented. The exception was Kaiser Permanente Health Plans, which operates 11 of its own hospitals in the area.
The NCQA, acknowledging it can't develop comparative initiatives in every market, is building a database of HEDIS information that's scheduled to be ready by August, said spokeswoman Ann Greiner.
At the request of Xerox Corp., the approximately 200 health plans with which it contracts will submit their data to the project, providing one source of data in a standardized format, Greiner said.
The market-by-market reports, by contrast, all differed at least a little in the menu of measures selected and the way they were reported, she said.