Somebody’s watching you, and it’s not just NCQA

Here’s a look at other plan assessment tools

If you haven’t yet heard the acronyms FACCT or CAHPS, you will soon. Large consumer groups, employer coalitions, and government agencies, unconvinced that the Health Plan Employer Data Information Set (HEDIS 3.0) adequately measures health plan performance, are developing their own measures they believe will provide more meaningful information to consumers. HEDIS 3.0 was developed by the National Committee For Quality Assurance (NCQA) in Washington, DC.

Several groups of national employers and government agencies are focused on improving information consumers need to make choices about health plans, says Dale V. Shaller, MPA, senior consultant for QMAS, the Quality Measurement Advisory Service in Stillwater, MN, a firm that helps business coalitions and other groups select the best health plan measurement sets for their own markets and needs.

Standardizing information

"NCQA has been trying for some time to develop measurement sets that are comparable across plan types," he says. "CAHPS and FACCT are a response to purchaser demand to better evaluate choice among competing products in the market. It’s an attempt to have these measures come not from the supply side on its own terms, but rather to develop measures with a demand-side focus. These groups are pushing health plans to provide standardized information about systems accountability. It’s not a new idea, but in the past few years, it has taken hold in a big way.

"There are real benefits to health plans in these efforts. Although they do call for even more accountability, these efforts also provide standardization, which helps purchasers compare plans more fairly. Plans must overcome the psychology of evaluation. The issue is no longer if you will be evaluated, but rather how you will be evaluated," Shaller says.

The Foundation for Accountability (FACCT) in Portland, OR, was created in 1995 by consumer groups, business coalitions, and government agencies, including the Health Care Financing Administration, to develop new measures of quality in health care. "FACCT focuses on measuring quality from the patients’ perspective," Shaller explains. "The measures look at things like whether people got the help they needed to recover from an illness or handle a chronic medical problem."

The FACCT measures apply to all types of health care, including managed care and traditional health plans. "The measures allow comparisons to be made between different types of systems so that purchasers can really choose what is best for them," Shaller says. "FACCT asks consumers what kind of information they want about health plans through focus groups and ongoing consumer participation. FACCT is also trying to find a way to present health plan quality data so that it is meaningful for consumers — so that when it is publicly available, probably in 1998, it’s in a form consumers can use."

The FACCT measures focus on two basic functions performed by health plans:

Care of all people.

How well do plans take care of their members, both the sick and the healthy? Does the plan understand the health needs of members? Does it offer programs that help people stay healthy and promote wellness?

Care of people with specific medical conditions.

How well does the plan treat members with specific conditions such as diabetes and asthma? "The thought is that measuring specific conditions highlights variations in quality within health plans," Shaller says. "A plan can do well in one area and still do poorly in another."

These two broad areas of study are measured by three separate approaches:

Steps to good care.

This includes administering needed tests, diagnosing patients promptly and accurately, counselling patients about treatment options, performing appropriate procedures, and pro-viding effective follow-up care.


This measures how well plans treat their members. Are patients treated with compassion, dignity, and respect? Are their concerns listened to and addressed? Is their service timely?


Does the health plan make a positive impact on member health? Does care help prevent illness or minimize its progression?

To date, FACCT has endorsed seven sets of measures and is helping health plan purchasers, health plans, and provider groups implement them. Each underwent a rigorous review by quality measurement experts, Shaller says. They are:

• asthma;

• breast cancer;

• diabetes;

• major depressive disorder;

• health risks;

• health status for the elderly;

• satisfaction.

"FACCTs’ major activity is using advisory groups to identify existing measurement sets that provide data most relevant to consumer needs. The group has focused a lot of energy on specific conditions and looks at them from both a clinical and administrative viewpoint," he says. The breast cancer data set’s eight measures, for instance, include early detection, helping patients make informed decisions, and five-year disease-free rates.

"What makes FACCT significant is the leadership level involved in the process. The Department of Defense is one of the groups involved. That’s a huge purchaser of health care in this country," Shaller says.

The Consumer Assessment of Health Plans Studies (CAHPS) is a big project funded by the Agency for Health Care Policy and Research (AHCPR) in Silver Spring, MD. "The project started in 1995 and is scheduled to run through 2000," says Shaller. "The focus of the project is to develop, test, and evaluate a standard approach to patient satisfaction surveys."

The project is now in its second, or demonstration, phase. "Right now, the measures developed in the first phase are being used to measure patient satisfaction with Medicaid managed care and fee-for-service plans. The set includes 50 questions about access to care and satisfaction with care received."

"Most health plans regularly survey their own members about satisfaction. The problem is that these surveys measure overall satisfac-tion instead of in-depth experience with plan features of importance to consumers. Instead of the health plan measuring things which help it improve market share, CAHPS measures things of importance to consumers," Shaller explains.

In addition, because each health plan uses its own "homegrown" satisfaction survey tool, there is no real way consumers can compare plans, he adds.

CAHPS measures go into detail about specific plan features. Areas measured on the survey include:

• access to specialists;

• quality of patient/physician interaction;

• coordination of care;

• care of chronic illness;

• transportation issues;

• mental health care;

• claims processing;

• communication/use of interpreters.

The items on the survey focus on five areas of interest:

• perceived quality of health plans;

• perceived quality of health care;

• enrollment/payment;

• utilization of health services;

• respondent characteristics.

AHCPR has developed a survey and reporting kit that helps health plans implement the CAHPS measurement tool. The kit includes the survey tool, a reporting kit, and an implementation handbook.

To request the CAHPS kit, contact the AHCPR Clearinghouse at (800) 358-9295 and request AHCPR Pub. No. 97-R013. You also can access the technical overview of CAHPS through its Web site at

For more information on FACCT, contact: FACCT, 520 SW Sixth Ave., Suite 700, Portland, OR 97204. Telephone: (503) 223-2228.

For more information about QMAS, contact: QMAS, 1940 Greely St., Suite 2028, Stillwater, MN 55082. Telephone: (612) 430-0759.