Despite a national backlash against managed care and pending legislation on patients' rights, managed care organizations are doing a better job than they are getting credit for in using quality measurements to improve patient care, a university researcher says.
"Politicians are saying HMOs are bad, are not measuring," says Dennis Scanlon, assistant professor of health policy and administration at Pennsylvania State University in University Park. But that's not so, says Scanlon: "There is a significant amount of measurement going on."
Scanlon is lead author of a study, released in July, that looks at how managed care organizations use performance measures such as the Health Plan Employer Data and Information Set (HEDIS) and the Consumer Assessment of Health Plans Survey (CAHPS) to improve the quality of care they deliver.
"Policymakers and the public are ill-informed about what quality means," Scanlon says. "The public and policymakers are assuming that more access to doctors and services leads to better care, but that is not necessarily true."
All the MCOs studied used the external performance measures for quality improvement, although at varying levels of sophistication. And the study found that certain MCOs--for example, those with closer relationships with their providers, those that had a national presence and those that were not-for-profit--tended to use performance measures more heavily.
When recent studies showed consumers themselves were not using HEDIS and CAHPS report cards to make provider selections, Scanlon and his team began a study to see whether managed care organizations were using the data to improve quality.
The researchers limited their study to 24 large plans that already were reporting performance measures. They surveyed CEOs, medical directors and directors of quality improvement from MCOs in Pennsylvania, Maryland, Kansas and Washington state.
Scanlon says he expected to find that the plans were not using the measures for internal purposes, but his hypothesis was wrong. Often the external measures were being used in conjunction with internal benchmarks.
Scanlon disagrees with the focus of the two versions of the patients' rights bill that Congress will resume debating this month. Allowing patients to sue HMOs would be useful in the most egregious cases of error, he says, but wouldn't do much for advancing quality of care in general.
For that, he says, "You have to engage in true quality improvement; you have to have standardized measures." Neither bill addresses standardization or coordination of care, he says.
Others agree with his assessment.
"Anything that supports access is good," says Nancy Wilson, M.D., vice president of clinical affairs for Irving, Texas-based VHA. However, she adds, "Confusing quality and access is something we shouldn't do."
While legislation has a role to play in peer review, confidentiality and patient rights, "quality is local, and you shouldn't use legislation solely to try to regulate quality," she says.
