"The public and policymakers are assuming that more access to doctors and services leads to better care, but that is not necessarily true," says Dr. Dennis Scanlon, assistant professor of health policy and administration at. "Many of the quality problems outlined in a recent report by the Institute of Medicine can be attributed to poorly coordinated care and inefficient processes for delivering care to patients.
"Although managed care plans are by no means perfect, they are subject to significant performance measurement and reporting requirements and have made significant changes over the last few years," he adds. "More plans have responded with systems designed to help doctors make better decisions for their patients, particularly in the areas of prevention and chronic illness."
Scanlon is lead author of a new study which looks at how managed care plans use performance measures to improve the quality of their health care. The researchers surveyed administrators and clinicians from health plans in four states: Pennsylvania, Maryland, Kansas and Washington. The study goal was to understand what, if anything, these plans were doing to improve the quality of care for their enrollees.
The researchers' findings are published in the July issue of the journal Health Services Research.
While quality improvement has become a key issue for many managed care plans, spurred by the requirements of accrediting bodies and public and private purchasers, there is still a significant variation among plans in terms of the ability to improve quality, the researchers say.
But HMOs, unlike their competing alternatives, are at least measuring and reporting performance, an important first step toward quality improvement, Scanlon says. However, not all plans are equally effective at ensuring that members receive high-quality care.
"It appears that the plans providing the best care are those with a tightly integrated relationship with the doctors in the plan, and that work together to develop programs for patients," notes the Penn State researcher. "But these often are the plans with less provider choice, which ironically, is contrary to what the public and lawmakers are demanding – unlimited access to providers."
The measurements that seem to be most helpful for quality improvement are not always those that are publicly reported to consumer groups or those contained in state report cards,. To really improve quality, an additional set of measures is often needed to identify the causes of problems and to identify a solution to those problems. While standardized measurement systems provide a basis for plan comparisons on a limited set of standardized measures, this "one size fits all" approach may limit the flexibility needed in quality improvement, the study notes.
Still, Scanlon says that the quality improvement will secure a more central seat at the health care table in the future, but he expresses concern that "legislation such as the patients' bill of rights may not address the issues important for quality improvement."
"What is really needed is not unfettered autonomy for health care providers, but an understanding about how best to coordinate health care organization, delivery and financing, and how to ensure that the marketplace provides enough financial incentives to make plans take performance measurement and quality improvement more seriously."
The study's co-authors are: Charles Darby, Agency for Healthcare Research and Quality; Elizabeth Rolph, RAND Corporation; and Hilary Doty, Penn State graduate student in health policy and administration. Funding support came from the Agency for Healthcare Research and Quality.
Journal
Health Services Research