Most managed care plans actively engaged in measuring quality

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Last Updated: 2001-07-31 17:41:46 EDT (Reuters Health)

By Karen Pallarito

WESTPORT, CT (Reuters Health) – Even if Americans win the right to sue their HMOs, it doesn't mean that the quality of care provided by the nation's managed care organizations will get any better, a Penn State researcher says.

"The public and policymakers are assuming that more access to doctors and services leads to better care, but that is not necessarily true," according to Dr. Dennis Scanlon, an assistant professor of health policy and administration at Pennsylvania State University.

Dr. Scanlon points to the groundbreaking Institute of Medicine report that blamed medical errors for as many as 98,000 deaths each year. Many of the problems outlined in that report stem from poorly coordinated care and inefficient processes for delivering care, "from children not being immunized to patients being given drugs to which they might have an adverse reaction," he said. Those aren't the sort of egregious problems that would necessarily lead to a lawsuit, he added.

Dr. Scanlon is the lead author of a new report on quality improvement in managed care organizations. He and colleagues from the Agency for Healthcare Research and Quality and RAND Corporation interviewed officers of 24 health plans in four states. The report appears in the July issue of Health Services Research, the journal of the Association for Health Services Research.

While the findings suggest a link between measurement and improvement, a patient's bill of rights "may not address the issues important for quality improvement," Dr. Scanlon said.

"I guess I would argue the ability to sue and the access issues [addressed in the patient's bill of rights]…in some ways pale in comparison to the quality and errors problem," he said.

All managed care organizations interviewed for the study use performance measures to some extent for quality improvement, the researchers found. But the degree and sophistication of those efforts varied widely, they say.

Plans affiliated with a large national managed care organization were more likely to be "significant users" of performance measures, the researchers determined. "For these plans it was not uncommon for the national office to have established specific reporting criteria and goals," they write.

One of the reasons the team conducted the study is to dispel some of the misinformation about what's happening in managed care, Dr. Scanlon said. Politicians often blame managed care administrators for interfering with doctor-patient care, but the reality is that physicians are widely involved in making the decisions that affect patient care, he said.

It's also true, he said, that plans are engaging in measuring quality, which is the first step toward improving quality. The study results show that plans typically use performance measures for targeting quality improvement initiatives, evaluating current performance, goal setting, identifying problems, and monitoring the progress of quality improvement initiatives.

"There's a lot of measurement and improvement going on in HMOs…and if you look at some of the best HMOs out there, there are some pretty good programs," Dr. Scanlon said.

Health Services Research 2001;36:617-639.

-Westport Newsroom 203 319 2700

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