Structuring Health Insurance Markets
Assessing Health Plan & Provider Performances
Providing Information to Purchasers & Consumers
Daniel Campion, Senior Program Manager, Alpha Center, Washington, D.C.
Sandra Robinson, M.S.P.H., Acting Director, Center for Quality Measurement and
Improvement, Agency for Health Care Policy and Research (AHCPR), U. S. Department of
Health and Human Services, Rockville, MD.
J. Marvin Bentley, Ph.D., Associate Professor of Health Economics, School of Public Affairs, Pennsylvania State University at Harrisburg, Middletown,
Leonard Fishman, Commissioner of Health, New Jersey Department of Health,
In order to achieve efficiencies through competition, reliable information about products and
services must be available in the marketplace. This session explored the role of the State in
assessing the performance of health plans, hospitals, and physicians and in disseminating such
information in useable formats to purchasers and consumers. It highlighted the fundamental choice
States face in either producing information to promote competition, or letting purchasers and
consumers fend for themselves.
In his opening remarks, Dan Campion noted that States have three main roles in producing and
disseminating information about health plans and providers:
- As a large purchaser of care, the State can use its leverage to ensure quality.
- As a neutral body, the State represents the broader public interest, which can supercede its particular financial interest as a purchaser.
- The State can be a rich source of data, that can maximize the use of data it already collects, as well as seek to enhance or incorporate any new data collection efforts.
Sandra Robinson described the significant progress of AHCPR's Consumer Assessment of Health
Plans Survey (CAHPS®) project. CAHPS® is an easy-to-use kit of survey and reporting tools that
provides accurate and useful information to help consumers and purchasers assess and choose a
health plan. The kit contains a set of questionnaires that ask consumers about their experience with
their health plans, sample formats for reporting results to consumers, and information to help
sponsors implement surveys and produce the reports.
Two key objectives of the project are to improve comparability of consumer information through
standardization and to evaluate the usefulness of specific types of information. CAHPS® builds on
earlier surveys, such as the National Committee on Quality Assurance (NCQA) annual members
survey, used as part of Health Plan Employer Data and Information Set (HEDIS) 3.0. The current kit is the product of research and development
completed in the first phase of a 5-year project that began in 1995.
The project, which includes
ongoing field testing and demonstrations, is implemented through cooperative agreements between
AHCPR and a consortium led by Harvard Medical School, RAND, and the Research Triangle
Institute. Several States have been designated as demonstration sites for testing the CAHPS® survey
and tools primarily with Medicaid enrolles and/or State employees in Florida, Iowa, Kansas,
Maryland, Massachusetts, New Jersey, Oregon, and Washington.
Beyond populations for whom they actually purchase coverage, States can also use the CAHPS®
survey in developing their own "health plan report cards," for dissemination to the general
Len Fishman described how the New Jersey Department of Health and Senior Services
has sought to fill the "information vacuum" in his State by using a tailored version of the CAHPS®
survey and audited NCQA survey data as the basis for their Statewide health maintenance organization (HMO) report card. They have
also released a report on coronary artery bypass graft (CABG) surgeries, which included hospital
risk-adjusted mortality rates for 1994-95.
Mr. Fishman noted that such report cards can be produced
fairly quickly and can be made more sophisticated over time. He believes that information is one of
the best consumer protections and that report cards can be effective tools for quality improvement.
Marvin Bentley described the efforts of the Pennsylvania Health Care Cost Containment Council, an
independent authority established by the Pennsylvania Legislature in 1986, to provide information to
the public about health care costs and quality. While the Council initially focused its analyses on
hospitals, it has subsequently reported physician-level data, and is now considering reporting
information about health plans, as well.
- Hospital Effectiveness Reports. Hospitals that performed poorly in quality of patient care in
the initial reports were more likely to make patient care improvements, based on outcomes
measured two years later. Improvement in patient care was more likely in hospitals in
competitive environments (Evans, 1997).
- CABG Surgery Report. The Council's report may encourage health benefits plans to compete
on treatment effectiveness and not just on convenience and charges. Price competition
encouraged hospitals to increase cooperation with staff surgeons and other hospitals in an
effort to improve their clinical outcomes (Bentley and Nash, 1998).
Dr. Bentley also summarized the outcomes of an evaluation of Missouri's obstetrics consumer
report, which found that such reports offer an "effective strategy in improving the quality of patient
care" (Longo, 1997). For example, after the guide was published, 33 percent of hospitals that did not have
nurse educators available to assist new mothers with breast feeding got them, 43 percent that did not have
car seat programs initiated them, and 50 percent of hospitals with no formal follow-up services started
providing such services.