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CONSUMER ASSESSMENTS AND PERFORMANCE OF MEDICARE
HEALTH PLANS NOW AVAILABLE ON INTERNET

For the first time in Medicare's history, beneficiaries and their families can now examine information assessing the quality of care provided by health plans contracting with the program as rated by other beneficiaries. The Health Care Financing Administration (HCFA) today began posting on the World Wide Web (www.medicare.gov) the results of a survey of more than 100,000 Medicare beneficiaries enrolled in managed care plans that participate in Medicare.

HCFA also is posting the results of a new assessment of the quality of care as demonstrated in seven audited performance measures, the measures most important to beneficiaries.

The new measures, part of the Consumer Assessment of Health Plans (CAHPS) and the Health Plan Employer Data and Information Set (HEDIS) provide Medicare beneficiaries and the public with information to help them make decisions about how they want to get their health care. Providing such information is part of the Clinton Administration�s comprehensive approach to strengthening patients� rights and emphasizing the quality of care provided to consumers.

"As more Medicare beneficiaries choose to enroll in managed care, they need comparative information on the quality of those plans so that they can make the best choice for themselves and their loved ones," said HHS Secretary Donna E. Shalala. "Information disclosure is a central element of any patients� bill of rights and we are proud to lead the way in this area."

Between February and May 1998, HCFA sent detailed surveys to about 136,000 Medicare beneficiaries, asking them to assess the quality of their health plans. More than 100,000 beneficiaries C a 74 percent response rate C completed the surveys, making it the largest consumer assessment survey of managed care ever conducted in the U.S. The survey was developed jointly by HCFA and the Agency for Health Care Policy and Research (AHCPR).

Beneficiaries were asked to indicate their satisfaction with their health plans. They rated their health plan on a scale of 1 to 10, with 10 being the best and 1 the worst. Almost half of those surveyed rated their plan a "10" and another 34 percent gave their plan an "8" or a "9." Nearly 70 percent of beneficiaries said their doctors "always" communicate well with them and another 23 percent said their doctors "usually" communicate well.

"These results should provide beneficiaries who are enrolled in health plans with additional peace of mind that their plans are well-regarded by their peers," said Nancy Ann DeParle, HCFA Administrator. "The CAHPS survey will be an important tool for other seniors and their families to use in deciding whether to join a health plan and, if so, which one to join."

"As a result of this extraordinary partnership between two government agencies, Medicare beneficiaries will have reliable, independent information based on evidence that will help them make informed decisions about their health and their health plans," said John M. Eisenberg, M.D., AHCPR Administrator.

A second national survey of Medicare beneficiaries currently was conducted by HCFA in the fall of 1998 and results are expected to be included in information to be mailed to each Medicare beneficiary in their 1999 Medicare&You handbook. This fall, HCFA also plans to conduct a survey focusing on beneficiaries who leave their HMOs. In 2000, HCFA will survey beneficiaries who have chosen to remain in the traditional Medicare program.

In addition to the consumer assessments, HCFA also today released information from the first Medicare HEDIS assessment of health plan quality. HCFA required plans to report 30 HEDIS performance measures and checked the seven measures most important to Medicare beneficiaries for accuracy. These include such vital health concerns as mammography rates, the use of life-saving beta blockers in heart attack patients, and eye exams for diabetics. The National Committee for Quality Assurance (NCQA) developed HEDIS and collected the information from the health plans. That information was subsequently independently audited by the New York-based Island Peer Review Organization.

ANCQA is proud to have worked with HCFA to provide meaningful quality information to Medicare beneficiaries," said NCQA President Margaret E. O'Kane. "HCFA�s use of HEDIS to help inform health plan decisions is a great example of how the public and private sectors can work together to drive accountability and improve health care quality for all."

According to the HEDIS data, Medicare managed care plans reported that, on average, approximately three-fourths of women between the ages of 52 and 69 enrolled in a managed care plan in 1996 and 1997 had at least one mammogram. In addition, three-fourths of beneficiaries age 35 and older who survived a heart attack during 1997 and were eligible for beta blocker therapy received a beta blocker prescription when they were discharged from the hospital. Half of all beneficiaries age 31 and older with diabetes received an eye exam in 1997. Some people with diabetes can be screened safely less than once a year, suggesting an optimal rate below 100 percent. Variations in clinical results suggest that these standards of care are not achieved uniformly by Medicare managed care plans, and HCFA hopes that each plan will continue to improve on their results.

In 1999, HCFA will also collect audited HEDIS performance measures from Medicare managed care plans about health care provided in 1998. The agency continues to work with NCQA, HEDIS auditors, health plans, and others to improve HEDIS and the data collection process.

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Note: HHS press releases are available on the World Wide Web at: www.dhhs.gov.