Patient Safety and Quality

Analysis of care quality is nearly universal among HMO health plans

Health maintenance organizations (HMOs) are almost universally collecting and reporting data on care quality measures that are often reported back to physicians or medical groups within the health plan's care delivery network, according to a new study. These quality measures are used to guide health plan efforts on quality improvement, as well as allowing the plans to set up pay-for-performance programs to encourage quality improvement by care providers. A smaller but substantial percentage of HMOs collect similar data on hospital performance, although most health plans have not based hospital payment on hospital quality performance.

The researchers surveyed all health plans with an HMO option in each of 41 randomly selected metropolitan statistical areas (MSAs), totaling 242 plans. They collected information about health plan enrollment in the market, whether the plan used primary care physicians as gatekeepers, accreditation by the NCQA or another organization, and ownership (for-profit or not-for-profit). They also inquired about whether the plan relied on salary, capitation (flat payment per enrollee), or fee-for-service to pay primary care physicians or groups of physicians within the plan. Finally, the researchers asked about the HMO's data collection programs at the plan and physician levels, selecting seven care quality measures (including one each for patient satisfaction, prevention, and mental health, and four measures for chronic disease management).

Almost all of the 242 health plans collected plan-level data on the seven outpatient measures examined by the researchers, ranging from 92.1 percent of plans that collected data on hypertension control and cholesterol management to 99.2 percent that collected information on patient satisfaction. Except for hypertension control, more than eight out of 10 plans targeted these measures for plan-wide improvement. However, demonstration of improvement ranged from 45.5 percent for breast cancer screening to 93 percent for diabetes care. A smaller proportion of plans collected data at the physician or physician-group level ranging from 50.4 percent for hypertension control to 81.4 percent for diabetes care.

For each measure, a slightly smaller percentage of plans provided the physicians with feedback based on the measures. Diabetes care was used most frequently (50.5 percent) for pay-for-performance programs, while diabetes care, breast cancer screening, and appropriate asthma medication use were the most frequently used measures (all above 20 percent) on health plans' physician report cards.

The study was funded in part by the Agency for Healthcare Research and Quality (HS13335). More details are in "Quality monitoring and management in commercial health plans," by Bruce E. Landon, M.D., M.B.A., Meredith B. Rosenthal, Ph.D., Sharon-Lise T. Normand, Ph.D., Richard G. Frank, Ph.D., and Arnold M. Epstein, M.D., M.A., in the June 2008 The American Journal of Managed Care 14(6), pp. 377–386.

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