The original hallmark of managed health care is to prevent illness and maintain the health of the individual. To this end, a majority of managed care organizations focus on an aggressive agenda to promote maternal and child health. However, patterns of access and utilization of maternal and child health care services varies greatly. The National Committee for Quality Assurance annually collects the Health Plan Employer Information and Data Set (HEDIS® ) as a means to measure and improve the overall quality of health care. In addition, NCQA collects consumer satisfaction surveys for both adults and children. By combining HEDIS and Adult CAHPS® 2.0H data, NCQA’s State of Managed Care Report in July 1999 found that plans that ranked in the top 25th percentile of CAHPS composites and ratings had higher rates of Childhood (72.4%) and Adolescent Immunizations (63.4%), as well as higher rates of women receiving prenatal care in the first trimester (88.1%) compared to the bottom 75th percentile (62.7%, 50.4%, and 83.3% respectively). Preliminary statistical analyses from Adult and Child CAHPS data show that adults rate their child’s experience with the health plan more positively than their own for getting needed care (p-value <0.001) and getting care quickly (p-value <0.001). Furthermore, NCQA will explore if satisfied customers are more likely to utilize the services available to them. By measuring both the frequency of preventive services provided and the consumer’s perception of their health services, NCQA will identify areas for improving the delivery and quality of health care.
Learning Objectives: 1. Recognize the importance of measuring preventive and maternal child health care services in the commercial sector of managed care 2. Articulate the processes involved in assessing the quality and standard of managed health care 3. Identify consumer issues specific to mother and child health in commercially managed health care
Keywords: Quality Improvement, Utilization
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: National Committee for Quality Assurance; Publicly Reporting Commercial HEDIS and CAHPS 2.0H Data Submissions
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
The 128th Annual Meeting of APHA