Every six months, PacifiCare Health System sends 1.5 million enrollees a report outlining how their clinic ranks compared with other clinics in the system.
The Quality Index ranks medical groups in 28 indicators of care in three categories: clinical quality, service quality and administrative services.
The HMO wanted to "provide credible and relevant information to consumers," says Sam Ho, M.D., vice president and corporate medical director of PacifiCare.
It is believed to be the first insurer in the country to provide quality reports to enrollees.
Providers get more detailed information every three months, while enrollees get summarized reports every six months.
The Quality Index, which was introduced in August 1998, ranks only California practices, although other states in PacifiCare's plans will have their own indexes by year end.
The index was born of quarterly provider profiles, a practice the company started in 1993. The 187 medical groups, with about 25,000 physicians, are compared with each other for a percentile ranking. Those practices in the top 10 percentile of each category--such as satisfaction with referrals and cervical cancer screening rates--are designated "best practices."
Studies have shown statistically significant increases in the number of people transferring to better performing groups and better performance in medical groups that were ranked lower, Ho says. Further, he says the reports have been an effective tool to get providers to improve their clinical and service performances.
There is a financial incentive to getting higher rankings. The better performing providers are rewarded with a higher capitation rate, Ho says.
PacifiCare's group capitation model pays providers varying amounts which are based on a percentage of the premium. The increases are incremental, so a half-percent increase in performance could mean a significantly larger portion of the premium. For example, the highest performing group could get 85% of a patient's premium dollar while a lower performing group could get 35% to 40% of the premium.
Ho says the HMO rates groups rather than individual physicians because the small number of patients treated may not provide a statistically valid number.
Consumers also get information on medical groups' performance in other areas: preventive care, helping the sick and living with chronic diseases. In the chronic disease category, for example, groups are rated on the number of patients who get beta blockers after heart attacks. Standards are being developed for a new category, changes at the end of life.
The information can be valuable for people who pay attention to it, says Ron Bangasser, M.D., medical director of Beaver Medical Group in Redlands, Calif. But he says he's not sure many patients do.
Bangasser adds that his 132-member multispecialty practice hasn't seen a large influx of patients to its eight sites. About 120,000 patients use the clinics.
"This is the kind of information that tries to help us do a better job," he says. Beaver Clinic also contracts with Ohio State University to conduct patient satisfaction surveys. "It's not all bad. It's not all good."
Information has to be given in a certain way to mesh with the surveyor's system, he says. Beaver Clinic's computer system compiles statistics on immunization rates and the number of diabetics who get eye exams differently than PacifiCare's, he says.
Even though individual patient charts indicate a good showing, Bangasser says his clinics don't score very well in those areas in the PacifiCare survey. "It's a process that needs to improve."