Patient Satisfaction in Quality of Managed Care

Patient Satisfaction in Quality of Managed Care

Aspect to be compared

Gender and Patient

Satisfaction in Managed Care, etc.

Stakeholder Perceptions of Quality in Managed Care Plans

Two Steps to Enhance Managed Care Quality

Author(s)/Date

Emily Weisman, MS

Martha Romans

Jacobs Institute of Women's Health

Washington, DC

Carolyn M. Clancy, MD

Paul L. Grimaldi, Ph.D.

To determine what the differences are and what variables might affect women patients' perceptions of the quality of managed care

To find out what attributes three different health care stakeholders, physicians, employers and consumers, value most in determining their assessments of the quality of managed care health plans

To explain the ramifications of two developments in managed care: the new application form for MCOs to become Medicare risk contractors, and the National Committee for Quality Assurance plan to begin performance-based accreditation.

Hypotheses

Determining what the differences between men's and women's perceptions of the quality of health care may mean to the outcome of care; hypothesis was that the differences were minor despite women's different patterns of visiting doctors.

The three stakeholder groups view quality differently; consumers want good care and good customer service; physicians want autonomy; employers want value at low cost and good work ethics and so on. Knowing the nature and extent of these differences would help managed care organizations better serve each group.

That the two steps enumerated will cause an increase in health care costs.

Subjects

The subjects were survey respondents of NCQA and contains 97,873 men and women aged 18 and over) who were enrolled in 206 commercial managed care health plans and completed the HEDIS/CAHPS survey administered between February and May 1999.

Focus groups of employees, physicians and consumers were used to develop information, which was followed up by a questionnaire.

None for this article per se; however, he identifies subject groups MCOs might survey vis-a-vis the two factors of managed care he is explaining

Location

Harrisonburg, Va. area

Equipment/Materials

As aggregate data was used from other studies, only computers and other data handling equipment would be needed.

Audiotape machines for the focus groups, as well as some means of transcription, and means of sending out questionnaires.

Virtually none.

Duration

Feb.-May 1999

Several phases, although specific length of time not given.

Procedure

Acquire data set from NQHA; decide which respondents' answers not to use; decide which variables to assess.

Conduct literature review; use information to structure questions for focus groups; include key attributes from focus groups in mail survey; assess survey response; write article.

Determine what information about each of the two programs will be included; gather information; write article.

Data Analysis

Techniques

Paired t-tests: Multiple linear regression analyses:

Gender-stratified multiple linear regression analyses.

Ratings by attribute; ratings by importance.

Results

Of nine measures of satisfaction, five show small but statistically significant gender differences.

The strongly significant gender differences attributable to small numerical differences in means reflect the aggregate nature of the data as well as the highly concentrated distribution of mean scores within genders.) On the rating of all experience in the health plan, women report higher satisfaction than men."

Results of the responses of each of the three groups indicated that each group ranked the important MCO attributes in a different order.

There were results in terms of a HEDIS measure of various medical procedures by three groups, commercial populations, Medicare beneficiaries and Medicaid recipients.

Conclusions (the authors')

First, although the mean gender

Differences in satisfaction are small, identifying the top and bottom performing plans for women could be useful information for consumers, purchasers, and health plans.... "Second, gender-stratified analyses of the predictors of satisfaction levels are useful for identifying mutable health plan characteristics that are associated with women's satisfaction and can be the focus of quality improvement efforts within health plans.

Third, the study suggests ways in which consumer satisfaction tools may be modified to improve sensitivity to women's health care."

Stakeholders of different groups perceive the attributes of MCO plans differently; the implications of this are that it is incumbent on designers of health plans to be careful to design them with those features most important to the consumers to gain greater acceptance.

The new MCO application form and the performance-based accreditation plan will cause health care costs to rise dramatically.

Authors' suggestions for further study (if any)

Is for-profit health service contradictory to good care or a perception of good care by women?

Additional study of care structure quality and perceptions of stakeholders.

Outline: Comparison of Studies

I. General subject area

A. Gender and Patient Satisfaction in Managed Care: definition

B. Stakeholder Perceptions of Quality in Managed Care Plans: definition

C. Two Steps to Enhance Managed Care Quality: definition of steps

II. Comparison of methodologies

A. Aggregate data

B. Focus groups, mail survey

C. Compiling published information

III. Literature review critique

B. As a tool to construct format of focus groups

IV. Compare probable reliability of findings

A. Assess amount of information in A and B. articles; assess source of information in C.

V. Assess need for further study

A. Should similar studies be carried out in a for-profit setting?

B. Is there a way to address the preferences/perceptions of all three stakeholder groups to serve all equally well?

C. Is there any possibility these new demands will change, and if so, how and when?

VI. Conclusion

VII. References

VIII. Exhibits

Introduction

The subject of managed care is not only in the news, but also in the minds of all the stakeholders in health care: health care consumers, physicians and other medical personnel, and employers from hospitals to managed care facilities. Three recent articles have attempted to shed some light on the various factors involved in either the perception of the quality of an MCO by those stakeholder groups (or in one case, part of a single stakeholder group) and on the quality of MCOs; in one case, commentary is made also on the cost of new programs designed ostensibly to enhance both the quality and perception of quality of MCOs. This one is, however, more an attempt to explain facts and processes already known and established than to discover new and helpful information, although it does offer helpful information.

Objective

Each of these studies has a different objective, although each is allied to the improvement of the perception of MCOs. The study by Weisman et al. concerns determining the variables that affect women patients' perceptions of the quality of managed care, while the Thompson study has as its objective determining much the same thing concerning the perceptions of three sets of stakeholders: patients, physicians and employers. The Thompson study is more simply presented and the information is less difficult to assess, although the researcher did new original research while the first study simply used available data obtained from another source. The Grimaldi article did not so much use data as retell information regarding programs already constructed in its single objective of explaining the demands and results of two new mandates that are supposed to enhance managed care quality.