Improving the Medicare Market Adding Choice and Protections (1996) / Chapter Skim
Currently Skimming:
I What Information Do Consumers Want and Need: What Do We Know About How They Judge Quality and Accountability?
I What Information Do Consumers Want and Need: What Do We Know About How They Judge Quality and Accountability?
Pages 270-289
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From page 270... ...
stimulated a still-burgeoning effort in theoretical and empirical work on quality assessment. Those who provide and finance health care, as well as the American public, are paying increasing attention to the quality of medical care (Berwick, 1989a,b; Bowen and Burke, 1988; Brook and Lohr, 1985, 1987; Caper, 1988; Cleary et al., 1991; Dubois et al., 1986; Hughes et al., 1987; Larson et al., 1988; Lohr et al., 1988; Meterko et al., 1990; Orient et al., 1983; Roper et al., 1988; Steffen, 1988)
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From page 271... ...
Patient reports can be extremely useful in evaluating the quality of medical care. Many critical aspects of medical care, such as difficulty obtaining care, waiting time in an office, adequacy of communication, education, pain control, and emotional support, and whether patients were appropriately involved in important decisions about their care, are not recorded routinely by hospitals, health plans, or individual clinicians.
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From page 272... ...
However, many of the instruments used in earlier research studies were not based on careful assessments of how patients define and perceive quality and did not explicitly incorporate patient priorities during the development of measures. For example, many patient satisfaction scales place substantial emphasis on amenities (attractiveness of waiting rooms, parking, hospital food, etc.)
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From page 273... ...
Focus groups have been used to identify the needs of ambulatory patients receiving care in emergency rooms, private doctor's offices, hospital outpatient clinics, community health centers, and managed care plans.
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From page 274... ...
Health plans are increasingly making information about patients' evaluations of their care publicly available. Reports describing such information often are referred to as "report cards." Although we now know a great deal about how consumers define quality medical care, we know much less about what information consumers would like to see in such reports and how they interpret and evaluate such information.
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From page 275... ...
• Consumers want an unbiased, expert source of judgment about health care quality. Many are skeptical about data collection or assessments performed by health plans, insurance companies, employers, and/or the government.
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From page 276... ...
The study found that few consumers, especially the elderly, understand how managed care works except in areas with high levels of penetration into the managed care market. Focus group participants in that study, however, were interested in comparative data on benefits and quality of care and descriptive information about how managed care plans function.
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From page 277... ...
Participants were much more interested in the opinions of their family members, friends, or neighbors than in those of their coworkers or other employees from their former places of employment. In 1994, NCQA conducted focus groups as part of the Consumer Information Project that included Medicare recipients.
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From page 278... ...
. The findings from the focus group and case study components of that study are similar to the findings from other focus group studies and to those from interviews that we conducted with state health insurance counseling programs and advocacy groups.
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From page 279... ...
The study found that 60 percent of Medicare beneficiaries switched managed care plans to preserve their preexisting relationship with doctors. Beginning in 1993, the Office of the Inspector General of the U.S.
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From page 280... ...
, and prepaid group practice plans to learn more about the type of information most often requested and to find out what kind of information seemed most helpful to potential Medicare enrollees and/or their family members inquiring on their behalf. We also interviewed a benefits manager from a large national employer about how information is disseminated to retirees (personal interviews with: HealthPartners, Minneapolis, Minn.; Harvard Pilgrim Health Plan, Boston, Mass.; Fallon Health Plan, Worcester, Mass.; The Family Health Plan, Tampa, Fla.; state insurance information hotlines in Arizona, California, Florida, Massachusetts, Missouri, Texas; GTE, Waltham, Mass.; HCFA, Baltimore, Md.)
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From page 281... ...
• Several insurance commission phone numbers required working through a maze of voice mail, only to end up with a recorded message asking the caller to leave a name and phone number. • Many staff who we spoke with expressed concern about making subjective recommendations, or even providing helpful information about what to look for in a managed care option, for fear of "influencing" beneficiaries or of "being censored by health plans." Interactive methods of presenting information are beginning to provide data about how consumers use "layered" information previously unavailable.
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From page 282... ...
All of the individuals from managed care plans interviewed indicate that their plans use a combination of written materials, educational group presentations, face-to-face meetings, and benefits hot lines to inform and educate Medicare beneficiaries about their plans. Some plans sponsor fairs and have support groups for caregivers, as another way of providing information and assistance to the elderly population.
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From page 283... ...
A Medicare manager from one of the largest and oldest managed care plans in the country talked at length about how value-conscious and shrewd potential Medicare enrollees have become, making almost actuarial-like decisions to compare how much they might save or lose, depending on their personal health needs and utilization history. Consumers on fixed incomes pay close attention to their outof-pocket expenses and would benefit greatly from a method of determining those costs that reflect their own health problems.
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From page 284... ...
Some of the information is descriptive and would be presented in tabular or narrative format. Other information would require standardized data collection from a sample of Medicare beneficiaries receiving care across all types of delivery systems.
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From page 285... ...
Finally, we recommend that AHCPR's Consumer Assessment of Health Plans Survey project incorporate the informational needs of Medicare beneficiaries into the design of surveys and report formats. This effort to collect national comparative data for all other consumers could serve as the vehicle for capturing and presenting information to the Medicare population in the future.
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From page 286... ...
A recent Price Waterhouse study on the impact of disenrollment estimates that it costs plans close to $1,300 per Medicare disenrollee. Medicare enrollees may be less likely to change their choice of providers if they are initially given better information.
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From page 287... ...
1993. Using patient reports to improve medical care: A preliminary re port from ten hospitals.
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From page 288... ...
1993. A causal model of health status and satisfaction with medical care.
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From page 289... ...
1992. Forces motivating the use of health status assessment measures in clinical settings and related clinical research.
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