Oregon health-care consumers told researchers they want information in report cards on how health plans really work—how referrals to specialists are handled and what happens when there is a dispute over access and coverage—but even the architects of the ambitious Oregon Consumer Scorecard Project (OCS) say they had difficulty getting good information from health plans on these key issues. Based on the experiences of the OCS research team, it is "easy to see why consumers have problems," said Pamela Hanes, Ph.D., assistant professor of public health and preventive medicine at the Oregon Health Sciences University, who directed the project.
Funded by the Agency for Health Care Policy Research (AHCPR), the Scorecard Project tested various formats for health plan report cards in the Oregon Medicaid population. The research helps fulfill a legislative mandate to develop a scorecard prototype for the Medicaid population so that recipients can evaluate plans before making a selection. Patient satisfaction, HEDIS measures and information on how health plans work were compiled in a 10-page booklet and tested in a series of consumer focus groups. A final report on the findings will be available in October. Among the Project’s major findings:
• Consumers express a strong desire for information on health plans in their own geographic area, as opposed to information on plans throughout the state. Specifically, rural recipients are not interested in information about health plans in cities.
• Consumers and health professionals think differently about what constitutes quality of care. Consumers judge health plans, health professionals and facilities on the basis of very personal measures, such as how they gain access to specialty care while professionals use population-based performance measures such as outcomes of
cancer treatment and growth and development indicators for children.
• Regardless of the scorecard format, consumers need access to a trained individual who can answer questions on the phone or in person.
• Consumers like having a variety of formats for reviewing information (such as interactive kiosks, videos), but printed scorecards should always be available because of their lower cost and ease of distribution.
As part of the OCS Project, researchers surveyed plans to obtain "navigational" information, which tells consumers how plans work, e.g. how they handle after-hour care, urgent care, maternity care, etc. Dr. Hanes said the problem with this kind of information is that "there is always a marketing patina over everything." This was an issue even when researchers reviewed compliance data supplied to Medicaid in an attempt to cull meaningful information..
It is a "tremendous challenge," Dr. Hanes said, to get information on how plans "in reality manage care." In a sense, this information is highly proprietary, she added. Managing care is what health plans are marketing, but "consumers want to know how it really works." This natural tension only emphasizes the need to "keep everyone at the table" and to have plans "buy into" the process. Participants in the research concluded that patient satisfaction measures probably must serve as a proxy for this kind of information.
Urban/rural split
Tina Edlund, research and evaluation coordinator for the Office of Medical Assistance Program in the Oregon Health Plan, said the OCS Project had an influence on the patient satisfaction survey recently conducted by the state. Plans were separately rated for patient satisfaction among urban consumers and rural consumers. In focus groups,she said, Medicaid recipients said they wanted to see results for "eastern Oregon, but they didn’t care about Portland.
"The urban/rural split is interesting and compelling," said Ms. Edlund. "The needs of those clients are different and we need to look at them differently." The patient satisfaction survey is not currently used in Oregon to help recipients choose plans, but as a tool in quality assurance. Ms. Edlund said the plans wanted urban and rural results to be separate because ratings were generally lower among rural consumers. The state agreed. "We didn’t want a plan to be disadvantaged because it was providing services in rural areas," said Ms. Edlund, who adds that rural health care delivery will be more of an issue in quality improvement efforts.
"Consumers are hungry for information that is reliable, non-biased and sophisticated," said Dr. Hanes. "They know that commercials and advertisements are not their reality and that marketing materials don’t give a true picture of what life will be like in that health plan." Consumers want to know the "real differences before they get into the health plan." The Oregon Consumer Scorecard Project emphasizes how difficult it is to produce data that is "reliable and stands up to scrutiny." It also emphasizes how difficult it is to interpret and respresent differences among health plans. Even if differences are statistically significant, they may not be clinically different. It’s important to have an objective third party that has the trust of all parties when compiling scorecard information, Dr. Hanes said.
Contact Dr. Hanes at 503-494-2561 or Ms. Edlund at 503-945-6500. Reports from AHCPR can be obtained in October by calling 1-800-358-9295.
Oregon Consumer Scorecard Project issues final report Consumers want report cards to tell them how health plans really work, but data is hard to ge
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