Thursday, May 13, 2010

Pushing for Market-Level Health Plan Performance Reporting

I attended my first NCQA Purchaser Advisory Council today and it was a great meeting. NCQA is addressing the latest in health reform issues, including exchanges, accountable care organizations, relative resource use and furthering its work in wellness/health promotion and medical home. I am excited about the tools and information NCQA is working on, most of which measure and report performance at a plan or vendor level.

But I am struck by the fact that although reporting at the plan or vendor level often works for individual employers, those of us involved in community-level change need this valuable information cut in a different way. For example, health plans in TN report their HEDIS measures at a statewide level. Works for employers that have employees across the state, but does not work for those of us wondering how plans are peforming in Memphis specifically. Another example is the wealth of information that will become available through NCQA's relative resource use reports, which, once again, look at the plan's performance across the entire state.

It is great to know how health plans perform, in general across TN, but it would be even more powerful and actionable to know how they perform in each market in TN. That would tell us more about our own providers and their performance and help identify what we need to improve locally and may even give us hints about how to improve it. Because of contracting methods here in Memphis, where plans contract either with Baptist or Methodist, but generally not with both, we could even begin to understand if there are any real differences in the quality and resource use between our two major hospital systems and their affiliated physicians.

Understanding whether these differences exist between Baptist & Methodist is critical to local employers, and their employees, in knowing where to go for safe, high quality, efficient care.

NCQA is pushing itself to be relevant, vital, and address the current issues that are even more important due to health reform. The next challenge will be how to make this information relevant and usable by communities as well as individual employers. I hope I can bring this perspective to NCQA as I continue to serve on their Purchaser Advisory Council.

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