Outcomes reporting: Are you ahead of the pack or playing catch-up?

NCQA accreditation, HEDIS requirement ‘raise the stakes’ for home care

The outcomes handwriting is on the wall: You will have to track and report patient satisfaction outcomes data more specifically than you probably do. And the agencies that don’t prepare for this now will lose business to the ones that move ahead, experts tell Homecare Quality Management.

Home care quality managers have long known that providing high-quality care wasn’t enough. The proof is in the documented outcomes pudding. But two recent deadlines for health plans have heightened the intensity of the home care outcomes measuring and reporting race. Here are the pressures on payers that will turn up the heat on home care quality managers:

HEDIS 3.0. Deadline: January 1997.

The Washington, DC-based National Committee for Quality Assurance (NCQA), which is the accrediting body for health plans, expects to release this month the final version of the Health Plan Employer Data and Information Set 3.0 (HEDIS 3.0), a set of 71 standardized performance measures that includes a standardized member satisfaction survey.

HCFA requires HEDIS measures

For the first time, the nation’s largest private and public purchasers of health care have asked that all health plans — those that serve commercially insured patients as well as those that serve Medicare and Medicaid patients — use HEDIS 3.0 to collect outcomes data, starting this month. The Health Care Financing Administration (HCFA) has required all managed care organizations serving Medicare populations to begin submitting data on HEDIS measures relevant to Medicare in January 1997.

While the HEDIS measurements currently are reported on a health plan level, rather than on a provider level, that could change in the future, according to Carol Cronin, a member of NCQA’s Committee on Performance Measurement, the broad-based group that developed HEDIS. "To make this relevant to consumers, we have to figure out what’s inside the plan [in terms of provider outcomes]," says Cronin, who also is senior vice president of Health Pages, a New York City-based consumer magazine. Consumers will be able to use HEDIS data to evaluate and choose among health plans.

Currently, many large employers use HEDIS "report card" scores to determine which health plans to offer to employees.

Home care will feel the pressure

"If the HMO is going to have to report back on their HEDIS forms, which go back to an employer, then that’s what is going to keep the HMO in business," says Sandra E. Kretz, PhD, administrator of disease management and special projects at Quantum Olsten Health Services in Indianapolis. "So they’re going to put pressure on the home care companies, because they subcontract out this service and they want to be sure they are not being disadvantaged by poor performance or poor satisfaction [ratings] on the part of their subcontractors. It’s a bread-and-butter type of issue."

Home care providers already should be measuring the satisfaction level of their patients and reporting that back to health plans, hospitals, employer groups, and other partners or potential partners, says Mary P. Malone, MS, JD, CHE, vice president of corporate development at Press, Ganey Associates, a patient satisfaction and outcomes measurement firm based in South Bend, IN.

"This will ultimately determine a home care agency’s success," she says. "[But] the existence of HEDIS and what it represents clearly points to the fact that the stakes are being raised in this game."

Enhance your relationship with payers

There currently is no requirement that home care providers use the standardized HEDIS patient satisfaction survey. But if providers use an adapted version of it to help health plans collect the satisfaction data HEDIS requires them to have about their members, they "can add to the robustness of the information they collect," says Rose Bemis-Heys, RN, NP, vice president of business development for Matria Health Care in Santa Ana, CA. (See related article with how-to tips on preparing for health plan demands, p. 3.)

"It could enhance your relationship with payers," Bemis-Heys says. "Do you want to be ahead of the pack or do you want to play catch-up? I want to know what my customer, the health plan, wants so I can be ahead of the pack. It’s too late if you wait until they ask. You have to design systems to collect the information before they ask.

Satisfaction data can prove value

"There are agencies that will wait until somebody says, ‘You’ve got to do this.’ So which one are you going to be?" she asks. "Are you going to see what factors the health plan will be accountable for and see how they might relate to [home care]?"

Additionally, collecting such satisfaction data could help you prove your agency’s value to the health plans with which it contracts, she says. For example, you may find that patients who received a particular type of home care are highly satisfied with the health plan, but they perceive your home care services as part of the health plan’s services. Or you may find that a group of home care patients’ satisfaction survey scores are higher than the health plan’s score as a whole.

"You could then say to the health plan, ‘We enhance your value,’" Bemis-Heys says.

Since health plans are going to be held to the HEDIS standard, you should be looking for ways to get the data they need as well as what you need to enhance your business, Bemis-Heys suggests. "Because if I make my customer look good, they won’t get rid of me."

New NCQA accreditation standards. Deadline: April 1997.

NCQA also expects to release this month its 1997 standards for health plan accreditation, which will become effective April 1. As did previous standards, the 1997 standards include requirements that health plans carefully credential subcontractors, such as home care providers, and carefully monitor the quality of their services.

"A lot of the demand for home care patient satisfaction and quality improvement activities is accreditation-driven," says Malone.

NCQA accreditation is increasingly popular among health plans, and as of Nov. 15, 1996, 339 health plans have sought accreditation. Nearly half of the nation’s HMOs are involved in the NCQA accreditation process.

Home care will be ‘scrutinized’

"The more health plans that contract with home care providers, then the more health plans there will be that are interested in being able to demonstrate that they are performing close oversight of [them]," says NCQA spokesman Barry Scholl. "More home care companies may be feeling the effects of that."

But some managed care organizations (MCOs) are expecting the NCQA’s 1997 standards to cause the accrediting body to become even more stringent in its evaluation of MCOs’ home care provider oversight, says Kretz.

"The new ‘97 accreditation standards put more of an emphasis on chronic illness and ‘vulnerable populations’ such as elderly and poor people, and they make the MCO document much more how they are treating these populations," she says.

"A lot of home care is to the elderly, the chronically ill, mothers with premature babies — these vulnerable populations. To the extent that home care companies participate in the care of certain patients, they’re going to be scrutinized because they affect overall patient satisfaction [with the health plan]."

Information capability will sell your agency

Previous years’ NCQA standards have required home care providers to furnish patient satisfaction data on a payer-specific basis, says Kretz. But in the past this was not enforced. "Many home care companies have not had the data sets to be able to tell what their patient satisfaction was on a payer-specific basis," she explains.

Bemis-Heys agrees. "Many agencies can’t tell you how much their care costs, much less if the patient was satisfied," she says. "But the time has come: Information will be the lead item to use to go in and sell the agency. Not your nurses’ credentials. Not your protocols. They’re going to look at [information] first."