Ensuring Quality Health Care
The Challenges of Measuring Performance & Consumer Satisfaction
Summary of a Workshop for Senior State and Local Officials
This workshop was designed to address the information needs of State and local health officials
from both the executive and legislative branches of government responsible for the design, conduct,
or regulation of health care quality-related activities. It was held in North Charleston, South Carolina, June 4-6, 1997.
About the Workshop Sponsor.
Overview
In recent years, tremendous changes have taken place within our Nation's health care delivery
system. With these changes, not the least of which has been the shift of significant portions of the
population into integrated managed care delivery systems, has come a greater emphasis on
measuring the quality of care provided by our health care systems, a notion often discussed but very
difficult to operationalize.
A number of reasons can be put forward to explain this increased emphasis on quality of care,
including:
- As health care cost increases have abated somewhat in the past several years, many
purchasers have shifted from focusing solely on the bottom line to emphasizing the receipt
of "value" for their health care dollar, i.e., purchasing effective care that will have a positive
impact on the health of the people whose coverage they are providing.
- The debate over managed care has included quality of care as one of its central themes.
Advocates of managed care argue that its integrated approach to providing care will result in
more coordinated, prevention-oriented, and efficiently delivered care, while critics express
concern that the financial incentives inherent in many managed care arrangements may
result in fewer services or inferior quality care being provided.
- Contracting directly with health plans gives many purchasers a sense that they can hold these
organizations accountable for the quality of care they provide.
- The explicit choices that many consumers must now make in selecting their health plans, and
the potential limitations on provider choice that may be associated with these decisions, has
increased both purchaser and consumer demand for more, and better, information about the
quality of care provided by these plans.
As the shift to managed care has increased the demand for quality of care information, the health
services research community has been pursuing a wide range of initiatives designed to increase or
measure the effectiveness of alternative treatment interventions and assess the performance of
different delivery systems. Many of these initiatives have been funded by the Agency for Health
Care Policy and Research (AHCPR). Although the progress in these areas to date has been impressive,
many questions remain to be answered.
In this continually changing health care environment with its evolving health care delivery systems,
State and local governments find themselves faced with responsibilities in a number of key areas
that could have an important influence on the quality of care provided by these systems.
For
example, State licensure requirements could influence the quality of care provided by health plans
that must meet those requirements. Both State and local governments acting as purchasers can
significantly influence the quality of care provided to their entrusted populations through their contracting efforts. In addition, there is the potential for them to play very important leadership and
oversight roles in promoting quality improvements that can benefit all members of the communities
they serve.
Objectives
To effectively carry out their responsibilities, it is necessary that State and local officials
address many challenging, and often technically complex, issues and questions, including:
- What are the different ways in which health care quality is assessed? What are the challenges
involved in developing appropriate and accurate quality measures?
- In what ways are different States using their regulatory responsibilities to promote quality of
care? How do these efforts relate to those of other entities, such as private accrediting
bodies?
- What strategies might State and local governments pursue when purchasing health care
services to promote quality of care? What special issues should they consider when
contracting for coverage of particularly vulnerable populations, such as the disabled?
- What quality-related information do consumers want to receive to help them make informed
choices about health plans or providers? How can reliable information about plan
performance be obtained from these consumers?
- In what other ways are State and local governments involved in promoting quality
improvement efforts and other health plan activities designed to improve community health
status?
This workshop was designed to help State and local health officials address these and other pressing questions
related to health care quality. While the purpose of the workshop was not to prescribe what policies
these officials should adopt in this area, it was intended to enable the officials who attended to make
more informed decisions with respect to health care quality-related policies and programs.
Participants
Participants were health officials from a broad
range of organizations, including: State legislatures; State Medicaid agencies; State departments of
insurance; State data organizations; maternal and child health bureaus; workers' compensation
programs; Federal, State, and local health departments; and national associations.
Workshop Sessions
The User Liaison Program (ULP) disseminates health services research findings in easily understandable and usable formats through interactive workshops. Workshops and other support are planned to meet the needs of Federal, State, and local policymakers, and other health services research users, such as purchasers, administrators, and health plans.
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