SCHAUMBURG, Ill., Nov. 30, 1999 - Despite the growing use of "report cards" in managed care, a new study from the Society of Actuaries shows that enrollment in managed care plans isn't yet linked to plans' "grades."
The study, "Managed Care and Performance Measurement: Implications for Insurance Markets," sought evidence tying managed care plans' ratings to plan enrollment - and, by implication, to employee choice. Researchers examined 18 published and unpublished studies, including surveys, focus groups, case studies and statistical analyses. Information about the links between ratings and enrollment can help managed care plans project future enrollments, useful in determining marketing direction, premiums and operating costs for a plan.
While the study noted "there is little current empirical evidence that consumers [employees of large employers] use this type of information in plan selection," the researchers said the ratings may be valuable now to purchasers and could be more worthwhile in the years ahead for consumers because:
- problem areas found in the rating process may be corrected, leading to better patient care, cost
savings or both;
- ratings reports may be refined, improving clarity for consumers and purchasers;
- ratings may be disseminated more widely, increasing usage by consumers.
Future research is needed, the researchers observed. Few studies to date have been able to focus on binding enrollment decisions made by employees. Furthermore, some important variables, such as family members' opinions of plans, have not yet been studied.
The study was conducted in light of the growing use of performance measurement systems, primarily HEDIS measures (Health Plan Employer Data Information Set). Large purchasers of managed care, such as corporations and state Medicaid programs, often require reporting of HEDIS ratings. Also, many purchasers require that plans be accredited by the National Committee for Quality Assurance (NCQA), which administers the HEDIS measures and uses them in the accreditation process.
Employers sometimes provide employees with NCQA accreditation status, specific HEDIS scores or both for plans offered, the researchers noted.
The researchers were Dennis P. Scanlon, Ph.D., assistant professor, Department of Health Policy & Administration, Center for Health Policy Research, Pennsylvania State University, and Michael Chernew, Ph.D., associate professor, Departments of Health Management & Policy, Economics and Internal Medicine, University of Michigan.
The report is posted on the Society's Web site ( www.soa.org/library/mancare.htm) and will be published in an upcoming issue of the North American Actuarial Journal.
The Society of Actuaries, with 16,500 members primarily in the United States and Canada, is the largest actuarial organization in the world. The Society provides basic and continuing education to actuaries and conducts actuarial research. Society members practice primarily in the fields of life and health insurance, pensions, employee benefits and investments.
EDITOR'S NOTE: For a complete report, journalists should contact Jackie Bitowt, Society of Actuaries public relations manager, at 847-706-3566, jbitowt@soa.org.
Journal
North American Actuarial Journal