Report cards to educate employers, employees

Recognizing that quality measurement tools such as HEDIS (the Health Plan Employer Information Set) are "still in their infancy," The Pacific Business Group on Health (PBGH), a West Coast alliance of 33 public and private purchasers of health care, has developed its own system of "report cards." These were designed to help employers and employees choose and rate HMOs, hospitals, and now, physicians groups.

The report cards are similar in appearance to the ratings illustrations found in Consumer Reports. The providers are listed along the left side of a matrix, and in each column, a score is given for a particular measure, such as "access to care." A key below indicates the numerical range for "average," "above average" and "below average."

"We just released a whole slew of report cards on health plans at the physician level," says Cheryl Damberg, PhD, director of quality for the San Francisco-based group. She says that of the 60,000 patients surveyed, 55% responded. "The patients were asked to evaluate their physicians in terms of satisfaction with care, perceptions of quality of service, and the quality of the care they received."

The patients were also asked what specific recommendations they were given if they were found to have certain health risks, such as high blood pressure or cholesterol. In addition, they were asked whether they received preventive services. Finally, using this information as their "baseline data," the alliance will eventually look back at two-year changes in health and functional status.

Damberg says the other report cards, which the PBGH have been producing for several years, have been beneficial. "I definitely think the data we have so far shows groups how they stand relative to their peers in the marketplace; they get to see how well they are doing across a host of care dimensions."

Generally, she says, the market tries to be responsive to consumers. "Issues like access to specialists, how long you have to wait on the telephone to get an appointment — there seems to have been some response to that," she says.

Damberg disagrees with claims she has seen in the media that managed care is somehow worse than other types of health care. "No one really knows," she says. "We have received a lot of anecdotal comments, and we have not found a significant difference in most categories between patients in a more heavily managed environment vs. a PPO, which is less managed. There was virtually no difference on the various aspects of quality."

Damberg sees employers "really trying to communicate" a lot of the quality data they are receiving back to their employees. And, she notes, "More and more purchasers are trying to make decisions about what plans to offer and who should be in them based on data that address quality. Ultimately, the consumer will benefit by employers making decisions to use higher quality plans."

[Editor’s note: We encourage you to visit the PBGH Web site at www.healthscope.org. Even if you don’t live in California, the information on how to choose and how to evaluate HMOs, hospitals, and PCPs — primary care physicians — could prove most valuable for you and your employees. You can contact the PBGH directly at: Pacific Business Group on Health, 33 New Montgomery St., Suite 1450, San Francisco, CA 94105. Telephone: (415) 281-8660. Fax: (415) 281-0960.]