Measuring the performance of HMOs is admittedly tricky. The chief problem is counting how many times a plan actually performs a particular service. Health plans with doctors on staff have a relatively easy time because patient records are centrally located. But companies like Prudential, which contract with physicians in unrelated practices, have to rely on whatever records their member physicians can provide. And because doctors are less good at record-keeping than they are at caregiving, they tend to underrepresent the services they provide. One of Prudential’s California plans scored nearly 20 percentage points higher on a prenatal-care measure when the company paid to review the charts of its individual patients. ““We’re delivering the care,’’ says Tony Kotin, Prudential’s chief medical officer. ““But Quality Compass doesn’t explain how data collection can [skew] a plan’s performance.''
Many other HMOs face the same problem, but they haven’t all decided to withhold information. So what’s motivating the dropouts? Do they have something to hide? At NEWSWEEK’S request, the National Committee for Quality Assurance (NCQA), the nonprofit accreditation group that created Quality Compass, studied the performance of two groups of health plans on 20 different quality gauges. The first group consists of 292 health plans that were completely open about their numbers. The second group contains 155 plans that shared data with Quality Compass (to establish nationwide averages and assess their own standing), but refused to let Quality Compass release the information to database users.
The result? In 1998, the disclosers scored significantly better in 18 out of 20 measures, and about the same in two (both involving mental health). The biggest disparities showed up in immunization rates for children and adolescents, eye exams for diabetics and the use of state-of-the-art drugs to treat heart attacks. The plans that shared their numbers sometimes performed poorly, yet those concealing their data almost always lagged behind. For example, the worst-performing disclosers provided follow-up care to 41.3 percent of women members following childbirth, while the worst-performing concealers followed up with just 22.3 percent.
Full disclosure does carry risks. And some plans try to minimize them without completely stiffing consumers. Cigna, whose plans dominated published lists of poor performers in 1997, pulled its scores from public view last year. But the company still shares information privately with employers and members who request it. Humana, which considers Quality Compass comparisons misleading, won’t even share them directly with its members. ““They can go to their health-benefits department,’’ says Humana spokesman Greg Donaldson.
Embarrassment is understandable. So is philosophical disagreement. But data-dodging compounds the widespread perception that HMOs put their own interests before their members’. And every time a plan opts to hide its performance, it gets easier for others to do the same. ““If nobody has to report,’’ says NCQA president Margaret O’Kane, ““I don’t know what the future of public accountability for health plans will be.''
What’s a consumer to do? Ask your company’s benefits department if your plan participates publicly in Quality Compass. Or check the Quality Compass Web site (www.ncqa.org) to find out. If your plan is a discloser, you can check its performance by scanning the Web site or calling 888-275-7585. If your plan is hiding its scores, you should ask why. You’d be nervous buying a car from a company that tried to keep you from comparing its safety record with those of competing models. At best, it means the company doesn’t respect your intelligence. At worst, it means there’s no intelligent reason to choose the company’s product.
