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Health Serv Res. 2001 July; 36(3): 619–641.
PMCID: PMC1089245

The role of performance measures for improving quality in managed care organizations.

Abstract

OBJECTIVES: To understand how managed care plans use performance measures for quality improvement and to identify the strengths and weaknesses of currently used standardized performance measures such as the Health Plan Employer Data and Information Set (HEDIS) and the Consumer Assessment of Health Plans (CAHPS) survey. DATA SOURCES/STUDY SETTING: Representatives (chief executive officers, medical directors, and quality-improvement directors) from 24 health plans in four states were surveyed. The overall response rate was 58.3 percent, with a mean of 1.8 respondents per plan. STUDY DESIGN: This exploratory qualitative research used a purposive sample of respondents. Two study authors conducted separate one-hour tape-recorded telephone interviews with multiple respondents from each health plan. PRINCIPAL FINDINGS: All managed care organizations interviewed use performance measures for quality improvement but the degree and sophistication of use varies. Many of our respondent plans use performance measures to target quality-improvement initiatives, evaluate current performance, establish goals for quality improvement, identify the root cause of problems, and monitor performance. CONCLUSION: Performance measures are used for quality improvement in addition to informing external constituents, but additional research is needed to understand how the benefits of measurement can be maximized.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Chernew M, Scanlon DP. Health plan report cards and insurance choice. Inquiry. 1998 Spring;35(1):9–22. [PubMed]
  • Goverman IL. Orienting health care information systems toward quality: how Group Health Cooperative of Puget Sound did it. Jt Comm J Qual Improv. 1994 Nov;20(11):595–605. [PubMed]
  • Hillman AL, Goldfarb N. Exemplary quality improvement programs in HMOs. Jt Comm J Qual Improv. 1995 Sep;21(9):457–464. [PubMed]
  • Kinney CF, Gift RG. Building a framework for multiple improvement initiatives. Jt Comm J Qual Improv. 1997 Aug;23(8):407–423. [PubMed]
  • Landon BE, Epstein AM. Quality management practices in Medicaid managed care: a national survey of Medicaid and commercial health plans participating in the Medicaid program. JAMA. 1999 Nov 10;282(18):1769–1775. [PubMed]
  • Landon BE, Tobias C, Epstein AM. Quality management by state Medicaid agencies converting to managed care: plans and current practice. JAMA. 1998 Jan 21;279(3):211–216. [PubMed]
  • Peterson MA. Introduction: politics, misperception, or apropos? J Health Polit Policy Law. 1999 Oct;24(5):873–886. [PubMed]
  • Scanlon DP, Chernew M. HEDIS measures and managed care enrollment. Med Care Res Rev. 1999;56 (Suppl 2):60–84. [PubMed]
  • Scanlon DP, Hendrix TJ. Health plan accreditation: NCQA, JCAHO, or both? Manag Care Q. 1998 Autumn;6(4):52–61. [PubMed]
  • Scanlon DP, Rolph E, Darby C, Doty HE. Are managed care plans organizing for quality? Med Care Res Rev. 2000;57 (Suppl 2):9–32. [PubMed]
  • Stolar MW. Clinical management of the NIDDM patient. Impact of the American Diabetes Association practice guidelines, 1985-1993. Endocrine Fellows Foundation Study Group. Diabetes Care. 1995 May;18(5):701–707. [PubMed]
  • Worrall G, Freake D, Kelland J, Pickle A, Keenan T. Care of patients with type II diabetes: a study of family physicians' compliance with clinical practice guidelines. J Fam Pract. 1997 Apr;44(4):374–381. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust