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Date:  May 4, 1995
Contact:  HCFA Press Office   (202) 690-6145

Medicare Peer Review Organizations in New York, California, Florida, Minnesota and Pennsylvania will be working with 23 managed-care organizations in testing indicators of quality of care.

The 18-month pilot, using performance indicators developed under a contract with the Delmarva Foundation for Medical Care, Inc., will test the methodology before possible implementation throughout the nation.

"Managed care is transforming the American health care system with much-needed emphasis on cost-containment, but the American people must be assured that the quality of care is not being compromised," Secretary Shalala said.

"The rapid expansion of managed care adds urgency to the need to establish a reliable system for tracking the quality of care provided by plans," she said.

Membership in health maintenance organizations is estimated at 50 million and is increasing at a rate of 11 percent a year. Approximately 2.3 million Medicare beneficiaries were members of HMOs on Jan. 1, 1995, an increase of 26 percent in one year.

Bruce C. Vladeck, administrator of the Health Care Financing Administration, stressed that the goal of the new system of quality indicators will be "continuous quality improvement with a minimum of regulatory burden.

"We intend to be a partner, not an impediment, in the process of improving the quality of managed care," he said. "The system will help managed-care organizations improve their quality management programs."

Core data to be collected will include the frequency of services provided to beneficiaries in the 18-month period and access to preventive health care services such as mammography and flu immunization. The pilot will also focus on care provided to enrollees with diabetes.

Peer Review Organizations, led by physicians, are under contract with Medicare in every state to review the quality of care in hospitals, health maintenance organizations and competitive medical plans, which are similar to HMOs.

In the pilot project, the PROs will shift from reviewing individual cases to concentrating on collecting data that will be used to measure the overall performance of the managed-care plans.

"The Peer Review Organizations will be advocates for Medicare beneficiaries and catalysts for quality improvements in the managed-care organizations," Vladeck said.