American College of Physicians: Internal Medicine — Doctors for Adults ®

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New quality measures reflect ACP recommendations

From the September 1996 ACP Observer, copyright © 1996 by the American College of Physicians.

By Michael J. Werner, JD

The newest version of the Health Plan Employer Data and Information Set (HEDIS)—the National Committee for Quality Assurance's tool for measuring health plan performance—incorporates several quality measures proposed by ACP. Inclusion of a measure is significant because the results are used by more than 330 managed care organizations nationwide and form the basis for many employer "report cards."

The new version, known as HEDIS 3.0 and released in late July, is designed to help purchasers and consumers of health care services evaluate the quality of managed care plans. Unlike earlier versions, which were criticized for looking only at processes of care as proxies for quality of care provided by health plans, HEDIS 3.0 focuses more on outcomes. It also requires HMOs and other participating health plans to collect information about the quality of care provided to their Medicare and Medicaid enrollees, as well as to their commercial patients. Earlier versions of HEDIS focused on patients enrolled in the plans through commercial insurance; commercial populations are generally healthier than Medicare and Medicaid beneficiaries.

The goal of HEDIS 3.0, which has been in development for several months, is to compare health plans in eight areas of performance: effectiveness of care; access to/availability of care; member satisfaction; informed health care choices; health plan descriptive information; cost of care; plan stability; and use of services.

Last December, NCQA received more than 800 suggestions from more than 170 organizations in response to "Call for Measures." Some of the new measures recommended by the College included in HEDIS 3.0 include: adult influenza immunization rates; rates of screening for cervical and breast cancer; percentage of smokers who were counseled by health plan providers to quit; a narrative description of the health plan's approach on using case management; and a requirement that health plans compare the functional status of their Medicare enrollees over time.

In addition, health plans are required to collect and report data for each measure by Medicare, Medicaid and commercial population. This holds the promise of providing data to highlight the quality of care each population receives. Health plans participate in HEDIS and other NCQA activities—including its accreditation surveys—voluntarily.

Not all ACP recommendations were included in HEDIS 3.0. For example, HEDIS 3.0 does not include measures of rates and types of geriatric screening and assessment and the availability of specific geriatric services, measures of the use of preventive services such as vaccinations for pneumococcal disease and hepatitis B, or measures that identify differences in health status among minority sub-populations.

The NCQA expects to finalize HEDIS 3.0 this fall, and release it to the public in December. ACP plans to submit a set of comments.

Michael J. Werner is Senior Associate for Government Relations in ACP's Washington, D.C., office.

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