Pa. Insurers Appreciate Push for Standardized Reporting

According to the NCQA, all six conditions account for up to 60 percent of all direct medical expenses. The Plan will also share the results of their internal quality reports with various groups, such as, Mr. Evans noted, employer groups and the Pennsylvania Health Care Cost Containment Council (PHC4), which works toward quality health care. FULL TEXT

The two major health-care insurers in northeast Pennsylvania are already one step ahead of the curve when it comes to reporting about quality measures.

Geisinger Health Plan (GHP) and Blue Cross of NEPA (BC NEPA) use internal quality reports to better their organizations. The importance of quality reports comes to the forefront as the issue of health-care reform rises.

Meanwhile, the National committee for Quality Assurance (NCQA) makes the move toward publicly reporting on health plans' Relative Resource Use for patients with diabetes and asthma. NCQA is an organization that accredits more than 90 percent of the healthcare providers across the United States.

"Regardless of what happens with the change in health care, quality will always have to be at the forefront so every person can make judgments for themselves," said Dave Evans, RN, Geisinger Health Plan's director of quality and appeals. "Patients need to have information so they can understand where they want to go for care."

Both GHP and BC NEPA use Healthcare Effective Data and Information Set, or HEDIS, reports to gauge how they each compare with competitors and what they can do to better themselves.

HEDIS measures the quality of preventive health, chronic care and satisfaction of customers within health plans in America. The reports give patients the ability to compare plans "apples-to-apples," according to the NCQA's Web site.

Additionally, insurers and providers can sec where there is room for improvement.

In addition to the resource use measures on which NCQA already publicy reports--low back pain, chronic obstructive pulmonary disorder (COPD), cardiovascular disease and uncomplicated hypertension--it will begin reporting on resource use for patients with diabetes and asthma come 2010. According to the NCQA, all six conditions account for up to 60 percent of all direct medical expenses.

"I think it's just another way to get at the whole idea of transparency value for dollars spent," said Dr. Leo M. Hartz, vice president for clinical advocacy and chief medical officer for Blue Cross NEPA. "One plan may do very well with their quality reports, but the cost of providing that quality may be huge compared to the average plan. Plans, although high quality, may not be very cost effective."

Dr. Hartz said Blue Cross of NEPA has a similar report that is used internally and is not published publicly. Instead, the plan has created a physician profiling program in which physicians receive an "efficiency rating" based on what Dr. Hartz called Illness burdens" as compared to the overall cost of caring for a specific illness population. The number physicians are given depends upon that relationship.

"Part of that profile we give physicians on a yearly basis has quality utilization and efficiency measures," Dr. Hartz said. "They'll act on that information to the extent that perhaps they'll provide better quality services or maybe more cost-efficient services."

Blue Cross also utilizes the HEDIS reports to compare themselves to their competitors, one of which is Geisinger Health Plan, Dr. Hartz said.

"We go through a series of analyses, talk to several focus groups and run the data by physicians in our network to understand what they see as barriers to better quality services," he said. "I think because methodologies from one company to the next are likely to be different, it's good to have a sort of national standard that utilizes strict criteria for measures. It could measure effectiveness across insurance plans, rather than just one insurance plan."

Similarly, Geisinger Health Plan works toward quality service, Mr. Evans said.

"Publicly reporting quality information is the perfect way to judge the care we provide to our members," Mr. Evans said. "We work on strategies on how we can improve throughout the year. It's important to everyone working in the plan. We set our goals around that information."

Mr. Evans also noted that Geisinger Health Plan's quality reports are available to the public via its Well site. Additionally, physicians have username/password access to a special section on the Web site to look at his or her own information.

"Doctors are pretty competitive. They want to see how they're doing," he said, adding, "We do our best to make sure our members are informed."

Mr. Evans described how Geisinger Health Plan also makes phone calls to its members to talk about procedures and visits to their physicians and why those trips are important. The Plan will also share the results of their internal quality reports with various groups, such as, Mr. Evans noted, employer groups and the Pennsylvania Health Care Cost Containment Council (PHC4), which works toward quality health care.

What Geisinger Health Plan, Blue Cross of NEPA and regional plans across the United States have been doing for some time already the NCQA plans to refine the data collection and analysis process.

"Purchasers have long been calling for ways to make apples-to-apples comparisons among health plans on the basis of not just quality, but also efficiency," said Margaret E. O'Kane, NCQA president. "Given the rising costs of care, smart health-care shoppers are looking for the ability to choose plans that deliver the right mix of quality and value. Publicly reporting (Relative Resource Use) RRU measures will allow them to compare plans against national benchmarks, and one another."