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HMOs: responding to bad report cards
Insights
Health plan report cards help purchasers choose managed care. However, it remains unclear if plans adequately respond to low scores for quality improvement and communicate actions to purchasers.
Area of Science:
- Health Services Research
- Managed Care Quality
Background:
- Selecting health plans is challenging due to increasing similarities.
- Performance report cards are available to aid purchasers.
- The response of health plans to performance scores is a key concern.
Purpose of the Study:
- To investigate how health plans respond to performance report card scores.
- To determine if quality improvement initiatives follow low scores.
- To understand communication strategies between health plans and purchasers regarding performance.
Main Methods:
- Qualitative study involving interviews.
- Discussions with health plan leaders, healthcare consultants, and purchasers.
- Analysis of responses to performance scoring and quality improvement.
Main Results:
- Varies widely in how health plans address low scores.
- Inconsistent follow-up and communication with purchasers.
- Quality improvement is not a guaranteed outcome of report card publication.
Conclusions:
- Health plans need more robust strategies for responding to performance data.
- Effective communication and quality improvement actions are crucial for purchasers.
- The impact of report cards on actual quality improvement requires further investigation.
Abstract:
Differentiating one health plan from another is becoming increasingly difficult. But a plethora of report cards on plans' performance are now available to help purchasers pick and choose managed care for their members. When a health plan receives a low score--or a score lower than its competitors, be it ever so slight--does it respond appropriately? Are leaders adequately following up to determine the significance of the scoring, rectify the problem--and communicate that to purchasers? Is quality improvement an outcome of publishing report cards? TQL spoke with health plan leaders, healthcare consultants and purchasers to find out what some plans are doing--and what many should be doing.