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Introduction to State Health Policy
Making Sense Out of All the Fuss Over Managed Care
Robert E. Hurley, Ph.D., Associate Professor, Department of Health Administration, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA.
Gregg Meyer, Director, Center for Quality Measurement and Analysis, Agency for Health Care Policy and Research, Rockville, MD.
In response to the demands to reduce health care costs, purchasers have moved a greater proportion of the population to managed care organizations. The goals of this session were to:
- Describe the differences between various types of managed care plans.
- Highlight important public policy questions posed by the rapidly changing health care environment.
- Describe approaches that might be taken to ensure that quality of care is maintained and improved.
Robert Hurley, Ph.D., Associate Professor in the Department of Health Administration at the Medical College of Virginia, Virginia Commonwealth University, defined managed care as an array of techniques and structures promoted by purchasers to get more value for their health care dollar.
Dr. Hurley identified a number of different types of managed care arrangements (e.g., health maintenance organization, point-of-service plans) and examined the trends in managed care participation, enrollment, and financing over the last decade. He indicated that the future of managed care is uncertain because of the rapid evolution of the marketplace, and the role of the State in the managed care arena will continue to change as they face long-term care (LTC) issues, including but not limited to:
- Health maintenance organization (HMO) liability.
- Declining private coverage.
- Occupational licensure.
Gregg Meyer, M.D., Director of the Center for Quality Measurement and Analysis for the Agency for Health Care Policy and Research, discussed the importance and challenges associated with improving and measuring health care quality. He reviewed several performance and assessment efforts that seem to develop core sets of quality measures particularly under managed care arrangements, including:
- Health Plan Employer Data and Information Set (HEDIS) from the National Committee for Quality Assurance (NCQA)—a set of health plan performance indicators.
- Consumer Assessment of Health Plans (CAHPS®)—a survey tool used to measure consumer satisfaction with health plans.
- Foundation for Accountability (FACCT)—a set of focus groups that seek to develop consumer-oriented condition-specific measures.
Dr. Meyer noted that the development of measurement tools alone does not ensure improved quality. Meeting the future challenges of quality improvement requires:
- Accessible, relevant information.
- An increased pool of science-based evidence.
- Backing from organizational and policymaking leadership.
- Public and private research dollars
- Enhanced methods of measurement.
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