It's being called a new age of healthcare consumerism. Researchers are compiling hard data on outcomes as well as launching sweeping surveys in the less tangible area of consumer satisfaction.
The focus of all this activity is the patient. Consumers are polled for information about how HMOs need to improve care and compete more effectively. The studies also yield information that consumers can use to compare plans.
Among the efforts to collect hard data is groundbreaking work by the Foundation for Accountability. An alliance of public and private healthcare purchasers and consumer organizations, Facct is compiling state-of-the art performance measures the public can use to compare health plans.
Facct grew out of a series of meetings last fall with purchasers and consumers hosted by Paul Ellwood, M.D., president of the Jackson Hole Group, a health policy development organization that influenced the Clinton administration's healthcare sweeping reform plan.
Initially, academic researchers commissioned by Facct are compiling quality-measurement methods for specific diseases and conditions such as depression, coronary artery disease and asthma. Following public comment, the organization's board is expected to endorse a first group of measures by the end of May. Facct then will try to have the measures included in payer contracts with providers as well as in HEDIS 3.0, the National Committee for Quality Assurance's latest Health Plan Employer Data and Information Set, due out in three months.
Facct says its proposed performance measures will provide "a consumer voice on healthcare quality." (March 25, p. 54).
The foundation's work is supported by its members. But its work is only one piece of the larger effort of publishing and using the measures. That cost also will be borne by health plans and purchasers as they invest in systems to collect and make data available to consumers, a Facct spokesman said. He said it's too soon to estimate the total investment in the Facct enterprise, which is just 6 months old.
In another effort, the NCQA is compiling available quality-related information about HMOs in one database, so that consumers can compare health plans. The database will contain standardized reports of HMO performance as measured by HEDIS (March 25, p. 50.).
But researchers have not forgotten the importance of that intangible, consumer satisfaction. It seems to be a key measure of a health plan's success.
Towers Perrin, a national consulting firm, reports that, according to employers, "No matter how much this plan saves or how good the clinical care is, if patient satisfaction is low, we've (employers) lost half the battle." That's because the public generally equates quality with satisfaction.
Bruce Fried, director of HCFA's Office of Managed Care, likens the effort to define healthcare quality to the old story of several blind men trying to describe an elephant. Quality is different things to different people, and an HMO enrollee's perception of quality may have little to do with the quality of care received.
HMOs already have learned this lesson. Roger Taylor, M.D., executive vice president and chief medical officer at PacifiCare Health Systems in Cypress, Calif., said that whenever the HMO looked into complaints about quality, it found that 80% of complaints were the result of dissatisfaction with a customer service. Clinical quality was found to be "quite good," he said.
As a result, PacifiCare "created a course we call the `Art of Caring,' which is a little program to help (staff at) doctors' offices understand what a patient's perception of quality is and how it's important to reflect not only the clinical quality but also the service quality, Taylor said. Other HMOs have begun similar programs.
Stanley L. Padilla, M.D., vice president for medical affairs for Woodland Hills-based Health Net, the California subsidiary of Health Systems International, said that enrollees' view of "quality. . .is largely dependent on satisfaction." That's why Health Net is surveying its enrollee satisfaction and "using satisfaction to drive a lot of our undertakings."
Large employers and employer coalitions such as the Pacific Business Group on Health, a group representing more than two dozen public and private healthcare purchasers, have been measuring employee satisfaction with HMOs for several years. For example, Xerox has been surveying employee satisfaction every two years since 1990, said Helen Darling, the company's manager of healthcare strategy and programs.
In the future, Xerox and other employers also will be studying the Annual Member Health Care Survey, a standardized satisfaction survey developed by the NCQA in collaboration with purchasers, health plans and technical experts. The survey results will allow HMOs to provide consumers and purchasers information based on enrollees' opinions and experiences. HMOs are required to have the survey conducted by mail by an outside organization.
"Using an outside vendor to administer the survey is important because it enhances the credibility of data and improves data quality. Many consumers and purchasers are skeptical about results that are collected by the plans themselves," said Paul Cleary, professor of healthcare policy at Harvard Medical School.
The satisfaction survey likely will be included in the next version of HEDIS.
At the physician level, members of the American Group Practice Association are participating in a patient-satisfaction survey that so far has collected more than 12,000 surveys from nine multispecialty group practices. Data collection is currently under way in five more practices.
Patients in the survey are asked to complete a questionnaire addressing accessibility of care, quality of care and the quality of the overall doctor visit. The questions were adapted from the American Association of Health Plans' Visit-Specific Questionnaire. Results are reported to physicians in terms of the percentage of their patients who responded "excellent" to each question.
Recently, several other important new projects to measure patient satisfaction have been announced.
The $10 million federally financed Consumer Assessments of Health Plans Study, undertaken by the Agency for Health Care Policy and Research and HCFA, is testing the best methods to survey consumers in employer-sponsored health plans and those with Medicare and Medicaid coverage.
Patient-satisfaction questionnaires will be developed and tested for the AHCPR over the next five years by contractors led by Harvard University, the Rand Corp. in Santa Monica, Calif., and the Research Triangle Institute in Research Triangle Park, N.C.
HCFA's Fried said the Medicare population will begin to be surveyed by year-end (March 18, p. 21).
In another project, the Medical Group Management Association is collaborating with Response Healthcare Information Management, a Rhode Island-based healthcare data management and analysis firm, to produce a patient satisfaction and outcomes survey. "This project will identify and benchmark medical practice activities and establish a national repository of patient satisfaction and outcomes data" so medical practices can compare their activities to national benchmarks, the MGMA said.
The employee healthcare satisfaction surveys conducted by large employers like Xerox capture a great deal of "utterly fascinating" information, Darling said. They also provide information on perceived outcomes, she said. "We ask, `Do you feel better because of the treatment you've received,"' she said.
The companies also ask questions that measure health status. And what have large employers found? Generally, Xerox found that workers "are very satisfied with their plans, including people with a lot of medical problems," Darling said.
Still, a recent population-based survey of consumers in 27 markets conducted by the Evanston, Ill.-based Sachs Group found respondents weren't so happy with their HMOs (See related story, p. 112).