For example, suppose you ask a friend to judge two soda drinks, A and B, which are in two different glasses. Your friend tries each drink and then tells you that soda B is better. What made your friend decide that B was better? Did it have more bubbles? Was it sweeter? Did your friend like B?s color better? You would probably want to ask your friend why he thought that B was better. You would be asking your friend what measures he was using to decide that B was ?better.?
Knowing what measures are important to you applies in managed care quality information too. If you know what questions were asked and what information was looked at, you could better decide what information works best for you.
Each person wants different quality information. Do you want to know whether the doctors? offices are accessible by wheelchairs? Is it important to know whether the doctors speak other languages? Would you want to know how long patients have to wait for appointments? Each person will answer these questions differently.
Tip: Why not make a list of the things about a health plan or about doctors that are important to you? As you read the information about quality, you can see better what types of measures you will want to look for.
You should look at several different performance measures that are important to you. A plan may perform well on some things and badly on other things. It?s up to you to decide which measures are most important to you.
A standard of care may recommend how often a person sees her doctor, what types of tests should be done, and what kind of training the health care provider should have to give this type of care.
Be the Smart Consumer: Do you know the standard of care for your child?s special needs? If not, you may wish to contact the Title V agency near you or an advocacy agency for people with your child?s particular needs. At the end of this fact sheet, there is information on contacting those agencies.
What are performance measures?
- Delivery system capacity;
- Process measures; and
- Outcome measures.
- How many patients per doctor?
- What kinds of doctors and specialists are in the plan?s network?
- How well are the health care providers distributed around town?
- Do the doctors and the health care facilities offer services in other languages?
- Do the health care providers have proper training in what I need, including training in understanding other cultures?
- What is the most time and longest distance that the plan expects patients to travel for care?
- How long does a patient have to wait for an appointment?
- How often do the doctors in the plan join or leave the plan?
- Will my child have access to a pediatric special care center?
Suppose you knew that Plan A has a hospital and doctors? offices only three miles from your home. Plan B has a hospital and doctors? offices 25 miles from your home. Which plan is more convenient for your family?
Compare the delivery system capacity to the standard of care for your child?s condition. If the standard of care requires that your child have access to a specialty care center, does the health plan include this option?
As an example, suppose you had diabetes. It is very important for people with diabetes to see their health care providers regularly and to have their kidneys, feet, and eyes examined each year. The health care provider should show them how to check their skin for problems. The performance measures for Plan A show that people with diabetes only see their doctors and have their eyes and kidneys tested once every two years. Patients in Plan B see their doctors and get these tests each year, and the health care providers are expected to show patients how to care for themselves at home. Which plan is going to give you better care for your diabetes?
Outcomes measures look at whether the health care improves a person?s life. For people with chronic illnesses, good outcome measures mean having a satisfactory or good quality of life.
How often do children with asthma see their doctors? If the children are not seeing their doctors regularly, then the plan may not be providing enough care to keep good track of the asthma. If the children are seeing their doctors too often, this would indicate that the health plan is not providing health education so that families can keep the asthma in control. Process measures that show too high or too low use of services could be problems. If you look at the standard of care for children with asthma, it will tell you how many visits to the doctor would be considered ?normal.? Of course, each person is different. But the health plan should compare well to the standard of care for asthma.
Performance measures may only be collected for certain areas of service. A health plan may concentrate on making those areas look good. If a health plan knows that someone is only going to measure how well it serves people with diabetes, then the plan may work harder with those patients with diabetes. Those performance measures will not tell you how well the plan serves people with heart problems or mental health needs.
Who puts the performance measures together?
As mentioned in Fact Sheet #1, NCQA uses HEDIS to measure performance. Many health plans, state agencies, and employer groups use HEDIS standards to compare health plans. The Child and Adolescent Health Measurement Initiative (CAHMI), originally developed at the Foundation for Accountability (FACCT), is a set of consumer-centered quality measurement tools. CAHMI is now a project at the Oregon Health & Science University. Some of the CAHMI measures are included in CAHPS surveys and HEDIS. Some health plans use the CAHMI measures to look at their own services. The Agency for Healthcare Research and Quality (AHRQ) also has developed the Consumer Assessment of Health Plans (CAHPS) survey. This survey is given to members of health plans to get their opinions about their health care providers and the care that they receive. Fact sheet #5 tells more about consumer surveys like CAHPS
Where can I get the results of these measures?
You can find links on this fact sheet and the other fact sheets in this series to many Web sites where you can see the results of these measures. State Web sites provide the information for free. Some other Web sites or companies may charge you for the results. You may also want to ask your health plan for the results of their performance measures.
Text has been truncated. For full publication text, download document.