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Reporting on Health Care Quality and Satisfaction

[The following post was written by Erica Brode, ITUP intern.]

On March 10th, California’s Office of the Patient Advocate (OPA) released its 2011 Health Care Quality Report Card, analyzing quality and patient satisfaction measures for 9 HMOs, 6 PPOs, and 225 medical groups.

In many ways, the report shines a light on what is needed in our state as all but one of California’s HMOs performed above the national average. The majority of experience ratings declined, and there was increased confusion among new members in HMOs. In fact, a third of members were unable to find information about how much of a service or medication their HMO would cover.

Quality Reporting

Public reporting has been used as a means of holding health care organizations accountable and inspiring quality improvement efforts for many years. A recent systematic review of public reporting showed an increase in quality improvement efforts at the hospital level with mixed evidence on health outcomes. Some of these studies also uncovered the unintended consequences of health outcome reporting, including not intervening in higher risk patients and selective referral of high-risk patients out of state.

OPA’s Report Card is focused on measuring the process of healthcare, not health outcomes. It uses a star rating system to compare medical groups and physicians based on meeting National Standards of Care, which are agreed upon process measures such as ordering cholesterol tests for patients with diabetes. For health plans, the star rating is based on overall member rating for care accessibility and plan service. These types of measures help hold organizations accountable for the health care experience that is within their control, instead of evaluating them simply on health outcomes.

Takeaways

There is a lot we can learn from this report card. For instance, come 2014 when millions of Californians will be newly eligible for coverage, it will be critical that quality information is displayed in a user-friendly, streamlined way to consumers. The simplicity of the star rating system may be a great example for the California Health Benefit Exchange, through which customers will select plans based on quality and price. It is also important to note that the HMO selection process is becoming more confusing for new members in a time when we should be focused on streamlining the process. We should take a moment to reflect on our commitment to easily accessible healthcare coverage and the facilitation of a well-informed healthcare consumer.