Just because they're called "health maintenance organizations" doesn't mean they always maintain health. Wellness and prevention, two pillars of HMO theory, are sometimes jettisoned when health plans look for ways to trim costs.
The next generation of HEDIS, unveiled recently in Washington, puts these values upfront. HEDIS 2000 stresses the importance of diagnosing and treating chronic conditions to prevent them from blowing up into huge medical problems, such as stroke or heart attack.
HEDIS, or the Health Plan Employer Data and Information Set, measures health plan performance and is compiled by the National Committee on Quality Assurance. Employers and consumers can use HEDIS to compare plans.
The draft HEDIS 2000 asks health plans to measure how well they control hypertension, prescribe asthma medications, reduce emergency room visits for asthma, screen for Chlamydia and manage menopause.
Two measures introduced in HEDIS 1999 became mandatory: cholesterol management after a heart attack and comprehensive diabetes care. Health plans will report HEDIS 1999 data in June.
The comment period for the draft 2000 template ends March 19. The NCQA mailed the draft document to 2,500 organizations, and final specifications will be published in June.
"HEDIS 2000 will show us how well health plans are caring for some of their sickest members," said NCQA President Margaret O'Kane. "That's one of the true measures of a health plan: Will it take care of me if I get sick? HEDIS now measures the spectrum of care, from prevention to acute care to management of chronic illness."
The NCQA says the new measures are designed to focus the healthcare community's efforts where they can do the most good-on manageable illnesses or conditions for which treatments are underused.
The two new asthma measures, for example, are designed to control the condition. If fewer plan enrollees end up in emergency rooms, that means they're better managing their care. The proportion of enrollees with asthma who use anti-inflammatory inhalers will show how well the plan is educating its patients and providers.
Also, the new Chlamydia measure is designed to arrest the consequences of this serious disease, which if untreated can result in infertility. Therapies are inexpensive, but many women don't know they have Chlamydia, because they haven't experienced any symptoms. This measure, which was developed with funding from the Agency for Health Care Policy and Research, calculates the proportion of sexually active women ages 15 to 25 who received a screening test for Chlamydia in the past year.