SCHAUMBURG, Ill.-- Is quality really HMO members' Number 1 concern? How can managed care effectiveness be measured given the widely varying views of stakeholders? What are the pluses and pitfalls in one such tool, the Health Plan Employer Data and Information Set (HEDIS)?
These are among the questions addressed at a recent Society of Actuaries symposium, "Managed Care in a Time of Transition." Final edited transcripts of the symposium's sessions are expected to be offered publicly this winter. Advance transcripts are available now. Contact Jackie Bitowt, Society of Actuaries, (847) 706-3566, jbitowt@soa.org.
Highlights from the symposium include the following presentations. Overview and keynote address by Jeffrey Nohl, senior vice president, strategic planning and marketing services, Wisconsin Physician Services, Madison, Wis. Nohl's central vision of managed care is, "As much as HMOs and managed care organizations insisted they would be different than the traditional insurance companies that sired them, they have become their parents." Nohl also observes, "When Humana Health Care surveyed its members ... (Humana) discovered only one thing really mattered to consumers, and it was not quality. It was access. ... Most people already assume they are receiving quality health care from any licensed professional who's regulated by the state."
"What is Effective Managed Care?," Jill Schield, Northwestern University researcher; Alan Rosenberg, M.D., quality management and medical director, Aetna Health Plans, Chicago; James Murphy, consulting actuary, Howard Johnson & Co., Seattle (moderator). At the symposium, Schield stated: "HMOs are in it for the money (but) that can be said of every stakeholder. ... The question we are asking is, are all the changes and challenges facing stakeholders ultimately resulting in high-quality, low-cost medical care that improves the overall health of the population? We (are offering) some ideas for looking at managed care with an overall systems effectiveness perspective."
"Research on HEDIS 3.0 Measures (a research project of the Society of Actuaries)," Denise Love, director, and Luis Manuel C. Paita, research consultant, Office of Health Data Analysis, Utah Department of Health; Michael Chernew, assistant professor, Health Management and Policy, University of Michigan School of Public Health; Dennis Scanlon, Department of Health Policy & Administration, Pennsylvania State University; Troy Pritchett, consulting actuary, Milliman & Robertson, Seattle (moderator).
Noted Love in the session, "As a public servant, I'm accountable for the money that I spend on (HEDIS), and early on in the HEDIS data collection process I went to the scientists on my staff said, "We have a lot of data, and I'm going to have to sit in front of a legislative committee and say this is a good plan, this is a bad plan. I can't do that yet. So, we need to drill down into this and see what the data are telling us.' ... The Society of Actuaries and their RFP (request for proposals) was asking similar questions. ... At the end of the session, you will understand more about HEDIS as a tool for evaluating quality. Issues of data quality will be discussed, and we'll lay out a framework for systematically evaluating a complex array of performance measures to study health care quality."
Said Chernew, "(Health care consumers) like easy access, low prices, popular physicians. So what is the value of performance measurement? HEDIS ... was not developed for people choosing health plans. It was developed largely for purchasers to evaluate health plans. (It probably) incents the health plans to do a good job, to perform better in these areas because they have someone to answer to."
The symposium, held May 4-5 in Minneapolis, brought together medical professionals, health care researchers, health actuaries and other professionals for a wide-ranging discussion of hot topics in managed care.
Most speakers are available for interview. Contact Jackie Bitowt, Society of Actuaries, (847) 706-3566, jbitowt@soa.org.