Stakeholder Perceptions of Quality in Managed Care Plans
Two Steps to Enhance Managed Care Quality
Emily Weisman, MS
Jacobs Institute of Women's Health
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.
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.
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
Harrisonburg, Va. area
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.
Several phases, although specific length of time not given.
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.
Paired t-tests: Multiple linear regression analyses:
Gender-stratified multiple linear regression analyses.
Ratings by attribute; ratings by importance.
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.