Fall is back-to-school time, and the managed-care industry's annual report card shows its performance unchanged from a year ago and consumer satisfaction down slightly.
Late last month, the National Committee for Quality Assurance, an accreditation organization, released its second annual State of Managed Care Quality report, which is an overall assessment of the industry's performance. The NCQA also released its Quality Compass 1998, which rates individual health plans on quality and performance. Both reports are based on Health Plan Employer Data and Information Set, or HEDIS, data submitted voluntarily by 292 participating health plans. The information is designed to help employers and consumers choose health plans.
The NCQA expects the data to be widely reported and consumers to devour the plan-specific information, but spokesman Brian Schilling says it can be just as helpful to physicians.
"Physicians' stake in the information is even greater than consumers'. For a physician it's relevant every day," he says. "The quality data points them in the right direction as to which health plan will help them be a better provider, because there are a lot of things in a health system that can help or hinder them being a good provider."
The industry's overall performance essentially was unchanged from 1996 to 1997 in all but one area: Slightly more physicians advised patients to quit smoking this year, up to 64% from 61%. Overall enrollee satisfaction, however, decreased slightly to 55.7% from 56.3% in 1996.
According to the Quality Compass, there is wide variability among health plans on quality of clinical care, customer service and patient satisfaction. In Florida, for example, the number of eligible women who received a cervical cancer screening from their health plan ranged from 40% to 100%.
Reflecting strong regional variations, New England's health plans outperformed the rest of the nation's plans and rated highest in enrollee satisfaction. In that region, 94% of managed-care patients recovering from a heart attack received beta blockers. In the South Central region, however, only 55% of patients received the preventive drug.
Elsewhere on the quality-of-care front, the national average for adolescent immunizations was 52.2%; for beta blocker treatment, 73%; for Caesarean sections, 20.7%; for childhood immunizations, 65.4%; and for eye exams for people with diabetes, 39%.