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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Gerry Fairbrother, PhD1, James Luciano, MD2, and Heidi Park, PhD1. (1) The Division of Health and Science Policy, The New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, (2) Montefiore Medical Center, 200 Corporate Drive, Yonkers, NY 10701, (914)377-4689, gfairbro@nyam.org
Purpose: The purpose of this project was to determine if greater efficiency and less duplication could be brought about through collaboration between managed care organizations (MCOs) in collecting and reporting performance data. This study describes these processes for one performance indicator-breast cancer screening-in four health centers and three MCOs.
Background: Generally, physician networks in managed care settings have evolved to become highly differentiated (Berenson, 1998), with physician groups participating in many plans and plans contracting with many physician groups. Collecting and reporting data in such an environment is rife with duplication of effort and samples too small to be meaningful.
Design: The process by which data is collected from and communicated to providers is described for four health centers and three MCOs with large patient representation.
Results: Data is collected by MCOs from encounter or claims data and chart reviews as part of HEDIS or plan-specific reviews. With respect to data collection for HEDIS, four health centers reported from 6 to 20 visits per year from MCOs to review charts. The number of charts requested per visit ranged from a low of 6 to a high of 400, with a median of 108 charts. None of the health centers received formal feedback on performance from these reviews. However, individual physicians received feedback on breast cancer screening for their MCO-specific population, based on claims data only. This data was distrusted as being incomplete and inaccurate, however.
Conclusion: Greater efficiency and more meaningful reporting could be achieved from MCO collaboration.
Ref: Berenson, RA. Bringing collaboration into the market paradigm. Health Affairs. 1998. 17(6):128-37.
Learning Objectives: The participant of this session will be able to
Keywords: HEDIS, Performance Measurement
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.