Health Care Quality

Both the public and private sectors have turned to managed care to help control health care costs. In recent years, the number of Medicare beneficiaries enrolled in managed care plans and the number of plans contracting with Medicare have risen dramatically. Today, Medicare faces many of the same concerns that other purchasers face--particularly those involving quality of care. Some large corporate purchasers have begun to consider "value-based purchasing." As they buy care, some employers now ask for quality-related data for health care plans and take action on the basis of such data as they monitor the plan's performance. After collecting and using quality-related data, the purchasers GAO studied reported that, in addition to cost savings, they saw improvements in access to care and health plan services, as well as in employee satisfaction with health plan performance. Although the Health Care Financing Administration (HCFA) is, by virtue of the size of the Medicare program and the freedom of choice given to beneficiaries, a unique purchaser of managed care, several purchasers' quality of care strategies could be relevant to HCFA's administration of the Medicare program. These lessons include (1) educating employees about the meaning of quality-related measures when providing comparative information on health plan quality; (2) using collaborative- and compliance-oriented approaches to improve plan performance; and (3) continually looking for opportunities to make use of quality-related data, such as developing standards and benchmarks for plan performance.

GAO noted that: (1) after collecting and making use of quality-related data, the purchasers GAO studied reported that in addition to cost savings, they saw improvements in access to care and health plan services, as well as in employee satisfaction with health plan performance; (2) they realized such improvement by identifying opportunities to use quality-related data in selecting health plans, monitoring health plan performance, developing quality improvement initiatives with plans and taking other actions, and providing information on health plans to their employees; (3) while HCFA is a unique purchaser of managed care--by virtue of the size of the Medicare program and the freedom of choice provided to beneficiaries--a number of private purchasers' quality of care strategies could be relevant to HCFA's administration of the Medicare program; and (4) major lessons from large purchasers' experiences relate to the importance of: (a) educating employees as to the meaning of quality-related measures when providing comparative information on health plan quality; (b) using collaborative- and compliance-oriented approaches to achieve improvements in plan performance; and (c) continually looking for additional opportunities to make use of quality-related data, such as developing standards and benchmarks for plan performance.