In an environment increasingly suspicious of managed care, 25 HMOs in California will be letting it all hang out next week as the California Cooperative HEDIS Reporting Initiative issues its second performance report card.
The effort aims to give consumers and employers a way to compare health plans with greater confidence and ease.
The report by CCHRI, a coalition of health plans, large employers and providers, will be the first to include results based on data collected and validated by an external firm. Other coalitions across the country have accepted data self-reported by health plans, said Jonathan E. Conklin, director of Medstat Group, Santa Barbara, Calif., which gathered and validated the data. Medstat works with several other coalitions.
The report card, based on standardized measures of plan performance in the Health Plan Employer Data and Information Set, will show whether the plans' services to enrollees in 1995 were above average, average or below average in six key areas of healthcare: childhood immunization, prenatal care, diabetic retinal examination, and screening for cholesterol, breast cancer and cervical cancer. The report card will be issued June 24.
Each of the 25 HMOs paid Medstat $50,000 for the data collection and validation process. Conklin also said each plan spent an additional $25,000 to $50,000 in connection with the coalition's work.
"We'll make it available to the media in a press release and hope it will be widely publicized," said Art Small, vice president for health management programs at Prudential Insurance Co.'s healthcare group. "We want the public to know managed-care organizations are concerned and are taking action about these points."
The report card also contains important public health messages in the descriptions of services the plans are measuring, he said. For instance, the report card spells out the proper immunizations children should have received by their second birthday.
CCHRI issued its first report card in 1994, but it lacked the thorough external validation and close involvement by providers used in developing the new report card. The following year, plans were allowed to use two different data-collection methods, which the coalition found yielded information that "was more misleading than useful," Small said. So CCHRI "decided reluctantly" not to issue a report card last year.
This year CCHRI's report card will look different from those issued by other coalitions across the country because of its simple format similar to that used by Consumer Reports. There will be no numbers, just black circles for above-average performance, white circles for below-average performance and black-and-white circles for average performance (See sample graphic).
The format is the result of consumer focus groups conducted by CCHRI. "The groups told us they didn't want a lot of detail," Conklin said.
Along with the simple graphics presentation, the text explaining the report card also has been redrafted so it can be understood by someone with a sixth-grade-level reading ability, said Alison South, Medstat project manager for CCHRI. In 1994, the text was at the 12th-grade level. "We don't really believe we reached the consumer, only the healthcare community," she said.
Suzanne C. Mercure, benefits administration manager at Southern California Edison, one of the state's largest employers and a member of the Pacific Business Group on Health, sees good and bad in the new format. "Simpler is fine for part of your audience," and some people will be pleased, but others might want more information, she said. The coalition is learning with each year's effort, she said.
Another unique feature of the California report card is the level of involvement by the provider community, which cooperated with Medstat's gathering and review of some 45,000 medical charts from more than 7,000 physician offices statewide.
"What evolved is a much better understanding by the providers of why we're asking for this information*.*.*.*and of the need for better administrative data, so we wouldn't have to look in the medical record," Mercure said. That eventually could lead to provider support for an electronic medical record, she said.
"It sounds so simple, to try to find out if a kid got vaccinated. But when you try to do it on this scale, it gets complicated," Small said. This is a special problem in California, where more physician groups are paid on a capitated basis than anywhere in the country. With capitation, the physician spends less time filing claims documents with insurers or HMOs. "We took the wasteful process out of the loop, but lost a data source at the same time," Small said.
This is a problem the rest of the country will face as more physician groups accept capitation, Conklin said. But the rest of the country also could benefit from CCHRI's collaborative data-collection methods, he said.
A new sampling methodology made it possible to eliminate redundant requests for provider data in the case of physicians who served enrollees of several HMOs.
And because of increasing provider involvement in data collection, the percentage of medical records that couldn't be obtained for the latest report card dropped to 6% from 21% last year and 35% in 1994, Conklin said.
Despite that improvement, Conklin said staff- and group-model HMOs and fee-for-service plans, because they have more data available, still scored higher in the report card than independent practice associations and network-model HMOs.
"Fully capitated plans have a real hard time" demonstrating their performance because they don't have good claims data, he said. "It's important for employers and consumers to understand that."