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HEALTH PLANS/POLICY: It will stagger you to find out that health care competition may not result in better quality!

Now I want you all to sit down comfortably  and drink a glass of water before you read this article.  Says here (in a story cribbed from the academic journal Medical Care) that Health care competition may not result in better quality. The study found that HMOs in places where there was less competition between HMOs did better on HEDIS scores. Oddly those where there was more enrollment in HMOs also did better on HEDIS scores (though not as well on consumer satisfaction).  All suggesting that a single monopoly HMO probably does best of all on quality.  Um, does this sounds like anywhere we know? Well now you’ve all recovered from the shock, let’s review what little that we know on the subject.

a) Competition amongst health plans and HMOs is not about the competition to produce the best quality care. It’s about the competition to insure as many as possible of the people least likely to need it. Harsh but fair words.b) In general health plans have little ability to control what medical providers do, and providers are the ones who do the things that make up HEDIS scores. Consumer satisfaction with health plans has to do with customer service reps, not health care quality which the average consumer wouldn’t recognize even if it showed up as their prom date.c) The more health plans there are in an area the less each plan’s ability to get providers to do anything, as they’ll be responsible for a very small part of the provider’s businessd) As Porter, Enthoven and a host of other bright people have pointed out, competition such as it exists in the US system is in the wrong place (see point a).And e) no one in the real world, where people and employers vote with their money, cares about HEDIS or has even heard of it.

I hope no one working hard in a health plan feels too offended. Sorry for feeling bloody minded tonight, but my next chore is to do my taxes! I’m sure you understand!

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mosesDollymaxipaynemarthaHomework Help Recent comment authors
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moses
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maxipayne
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maxipayne

Hello
I would like to say about In general health plans have little ability to control what medical providers do, and providers are the ones who do the things that make up HEDIS scores. Consumer satisfaction with health plans has to do with customer service reps, not health care quality which the average consumer wouldn’t recognize even if it showed up as their prom date.
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maxi
Ohio Drug Treatment

martha
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martha

well its true that people seeking a health care provider don’t care about HEDIS at all.
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spike
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spike

My experience is in mental health, and the MBHO I worked for also spent a lot of money on NCQA accreditation and put effort into raising our HEDIS numbers. I can’t speak for the medical side of things, but in mental health, the HEDIS measures actually do correlate to quality treatment. The main measures were outpatient followup within 30 days of inpatient discharge and seeing a clinician within 2 weeks of first request. Followup appointments are crucial in reducing recidivism, and it’s important for prospective patients to see a clinician while they’re still in the window of time where they’re… Read more »

gadfly
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gadfly

Kaiser’s own research shows that people seeking a health care provider don’t care about HEDIS: http://kaiserthrive.org/gallery/view_photo.php?set_albumName=Kaiser-Reputation-Management&id=KaiserReputationMgt_02_0001 The same presentation later states that potential members don’t associate quality with “Report Cards”. I’ve read academic criticism of how NCQA ratings only drive providers to focus on report card items rather than encouraging them to uphold quality in general. Here’s a behavioral health article that questions Kaiser’s relationship with NCQA: http://www.psychjourney.com/Kaiser%20Study%20Series.htm. Kaiser employees have even been caught cooking the NCQA books: http://web.archive.org/web/20040311205722/http://www.ohio.com/mld/beaconjournal/6053369.htm Kaiser also connects bonus pay to report card scores: http://sky.prohosting.com/banality/kaiser/BonusPay.pdf Kaiser PR people, however continue to cite NCQA in articles and… Read more »

J.C.
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J.C.

I work at a health plan and I am not offended. It is true. Competition in an area is mostly driven by market share. Which in turn is mostly driven by price, not HEDIS (most people have never heard of it, or care for it). Part of the reason for this because of the backlash against managed care plans which caused most plans to simply back away from the mission of “directing treatment”. HEDIS is worthless to a healthplan because patients and providers do not welcome the intrusion. If patients were really concerned about quality they switch doctors or hire… Read more »