CONSUMER REPORTS: Examines Health Plan Quality
While "[a]ccess and price have dominated the health care debate," Consumer Reports warns that consumers continue to lack access to "good comparisons of health plans on measures like" correct doctor diagnoses, effective treatments and medical mistakes. Trudy Lieberman reports that the dilemma of when doctors must give care, as opposed to when they should give care, has spurred the National Academy of Sciences' Institute of Medicine to "cal[l] for a major national effort to rethink how health care is delivered and how quality is assessed and improved." William M. Mercer health care consultant Michael Millenson said, "The public thinks the key to high-quality care is quick access to a doctor. That's only half. The other half is what the doctor does. It's amazing how we've ignored that" (Lieberman, 10/98 issue).
While managed care plans have received substantial negative media coverage for denying treatment coverage and underusing medical services, Consumer Reports found that traditional fee-for-service plans -- typically criticized for overuse -- also experience underuse problems. Furthermore, medication errors are one highly visible quality problem characteristic of both managed care and FFS systems (CR release, 9/16). Lieberman lists two additional problems that hinder high quality health care: "Purchasers of health care, primarily employers have yet to demand that their dollars buy good care," preferring instead to base decisions on price; and "[i]nformation systems are inadequate to give doctors easy access to all the information they need when treating patients." Consumer Reports also found continuing "shortcomings" with the National Association of Quality Assurance's key health plan quality measure: "Most of the data are still not audited and won't be until 1999; variations in data-collection methods are still permitted; and it's hard to interpret what the data mean when they are used to compare plans."
Head Of The Class
In an attempt to fill the quality assessment gap, Consumer Reports contacted Medicare managed care plans and questioned them on "quality improvement activities in five areas: underuse, overuse, misuse, how well seniors are functioning in daily life and the single quality improvement the plan was most proud of." The magazine used the results to compile a list of 16 "HMOs leading the way." In alphabetical order, plans making the list were:
- Aetna U.S. Healthcare
- Blue Cross-Blue Shield of Massachusetts
- Elderplan (NY)
- Fallon Community Health Plan (MA)
- Harvard Pilgrim Health Plan (MA)
- HealthPlus of Michigan
- HIP Health Plan Of New York
- Independent Health (NY)
- Inter Valley Health Plan (CA)
- Keystone 65 (PA)
- PacifiCare of Arizona
- Peoples Health Network/Tenet Choices 65 (LA)
- Physicians Health Services (CT)
- Rochester Area HMO-Preferred Care (NY)
- SecureHorizons Tufts Health Plan for Seniors (MA)
- Security Blue (PA)
Consumer Reports offers the following suggestions to help ensure that readers will obtain high quality health care from managed care plans:
- Get to know your primary care physician, "but don't trust the doctor so much that your judgement is clouded."
- Educate yourself about your health.
- Take advantage of preventative care services offered by health plans.
- Determine what HMO safeguards exist against dangerous drug interactions.
- "Don't hesitate to use" your plan's hot line for medical questions.
- Use quality report cards "as the bases for more questions," not "the end of your search."
- Although NCQA data are "imperfect ... they at least indicate that a plan has begun to measure certain health interventions." NCQA "[a]ccreditation does not guarantee great-quality care, but it shows a plan has put some processes in place to monitor quality."
- Readers are urged to quiz plans on "which quality-improvement activity they are most proud of. If plan representatives can't name one, go elsewhere if you have a choice."
- "Look for evidence the plan has investigated health problems, tried to fix them, and then remeasured to see if their interventions improved their members' health" (10/98 issue).
Note: Trudy Lieberman is Consumer Reports' Health Policy Editor. She also serves as an unpaid member of the NCQA board of directors. This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.