Managed Care


Data on Quality Lacking for Docs

MANAGED CARE October 2007. © MediMedia USA
News and Commentary

Data on Quality Lacking for Docs

MANAGED CARE October 2007. ©MediMedia USA

A baseline report issued by the National Business Coalition on Health called the "eValue8 Cornerstone Report: Measuring the Success of America's Health Plans" finds that price transparency is still in its infancy and that there is a wide variation in plan performance when it comes to promoting transparency, care improvement, and information technology. The variation suggests that improvement is achievable and needed.

The report says that insurers are better at providing quality information about hospitals than about physicians, as only 6 percent of health plans report standard physician performance measures to members for clinical conditions (e.g., diabetes or cardiovascular disease). In contrast, almost 30 percent of plans provide reports to members about hospital quality in such areas as heart attacks and pneumonia.

"Managed care organizations are moving away from medical approvals ... and moving towards a more global role, such as transparency — measuring the performance of the physicians in their network and sharing that with their members," says Dennis White, senior vice president of the National Business Coalition on Health.

"The challenge for medical directors is getting measurements in place, which means measuring physician performance and sharing it with members and also providing feedback and bonuses to physicians as a reward."

Health plans are in a position to "connect the dots," says White. "Plans know when prescriptions are filled by the patient; plans know what lab tests are done. The physicians could know, but their practices are not structured to notice if a lab result is missing. We encourage plans to provide that information and use the data that is at their command."


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