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Structuring Health Insurance Markets

Assessing Health Plan & Provider Performances

Providing Information to Purchasers & Consumers


Daniel Campion, Senior Program Manager, Alpha Center, Washington, D.C.


Sandra Robinson, M.S.P.H., Acting Director, Center for Quality Measurement and Improvement, Agency for Health Care Policy and Research (AHCPR), U. S. Department of Health and Human Services, Rockville, MD.

J. Marvin Bentley, Ph.D., Associate Professor of Health Economics, School of Public Affairs, Pennsylvania State University at Harrisburg, Middletown, PA.

Leonard Fishman, Commissioner of Health, New Jersey Department of Health, Trenton, NJ.

In order to achieve efficiencies through competition, reliable information about products and services must be available in the marketplace. This session explored the role of the State in assessing the performance of health plans, hospitals, and physicians and in disseminating such information in useable formats to purchasers and consumers. It highlighted the fundamental choice States face in either producing information to promote competition, or letting purchasers and consumers fend for themselves.

In his opening remarks, Dan Campion noted that States have three main roles in producing and disseminating information about health plans and providers:

  • As a large purchaser of care, the State can use its leverage to ensure quality.
  • As a neutral body, the State represents the broader public interest, which can supercede its particular financial interest as a purchaser.
  • The State can be a rich source of data, that can maximize the use of data it already collects, as well as seek to enhance or incorporate any new data collection efforts.

Sandra Robinson described the significant progress of AHCPR's Consumer Assessment of Health Plans Survey (CAHPS®) project. CAHPS® is an easy-to-use kit of survey and reporting tools that provides accurate and useful information to help consumers and purchasers assess and choose a health plan. The kit contains a set of questionnaires that ask consumers about their experience with their health plans, sample formats for reporting results to consumers, and information to help sponsors implement surveys and produce the reports.

Two key objectives of the project are to improve comparability of consumer information through standardization and to evaluate the usefulness of specific types of information. CAHPS® builds on earlier surveys, such as the National Committee on Quality Assurance (NCQA) annual members survey, used as part of Health Plan Employer Data and Information Set (HEDIS) 3.0. The current kit is the product of research and development completed in the first phase of a 5-year project that began in 1995.

The project, which includes ongoing field testing and demonstrations, is implemented through cooperative agreements between AHCPR and a consortium led by Harvard Medical School, RAND, and the Research Triangle Institute. Several States have been designated as demonstration sites for testing the CAHPS® survey and tools primarily with Medicaid enrolles and/or State employees in Florida, Iowa, Kansas, Maryland, Massachusetts, New Jersey, Oregon, and Washington.

Beyond populations for whom they actually purchase coverage, States can also use the CAHPS® survey in developing their own "health plan report cards," for dissemination to the general population.

Len Fishman described how the New Jersey Department of Health and Senior Services has sought to fill the "information vacuum" in his State by using a tailored version of the CAHPS® survey and audited NCQA survey data as the basis for their Statewide health maintenance organization (HMO) report card. They have also released a report on coronary artery bypass graft (CABG) surgeries, which included hospital risk-adjusted mortality rates for 1994-95.

Mr. Fishman noted that such report cards can be produced fairly quickly and can be made more sophisticated over time. He believes that information is one of the best consumer protections and that report cards can be effective tools for quality improvement.

Marvin Bentley described the efforts of the Pennsylvania Health Care Cost Containment Council, an independent authority established by the Pennsylvania Legislature in 1986, to provide information to the public about health care costs and quality. While the Council initially focused its analyses on hospitals, it has subsequently reported physician-level data, and is now considering reporting information about health plans, as well.

Dr. Bentley presented peer-reviewed research findings on the impact of various Council reports on overall hospital effectiveness and CABG surgeries, including the following:

  • Hospital Effectiveness Reports. Hospitals that performed poorly in quality of patient care in the initial reports were more likely to make patient care improvements, based on outcomes measured two years later. Improvement in patient care was more likely in hospitals in competitive environments (Evans, 1997).
  • CABG Surgery Report. The Council's report may encourage health benefits plans to compete on treatment effectiveness and not just on convenience and charges. Price competition encouraged hospitals to increase cooperation with staff surgeons and other hospitals in an effort to improve their clinical outcomes (Bentley and Nash, 1998).

Dr. Bentley also summarized the outcomes of an evaluation of Missouri's obstetrics consumer report, which found that such reports offer an "effective strategy in improving the quality of patient care" (Longo, 1997). For example, after the guide was published, 33 percent of hospitals that did not have nurse educators available to assist new mothers with breast feeding got them, 43 percent that did not have car seat programs initiated them, and 50 percent of hospitals with no formal follow-up services started providing such services.


Darby M. February 1998. Health Care Quality: From Data to Accountability. National Health Policy Forum background paper. Washington D.C.: The George Washington University.

California Consumer HealthScope, Pacific Business Group on Health.

Thompson W, Bost J, Ahmed F, et al. Trends: The NCQA's Quality Compass: Evaluating Managed Care in the United States. Health Affairs 17(1):152-8.

Meyer JA, Wicks EK, Rybowski LS, Perry MJ. March 1998. Report on Report Cards: Initiatives of Health Coalitions and State Government Employers to Report on Health Plan Performance and Use Financial Incentives. Economic and Social Research Institute.

Davis K. October 1997. Assuring Quality, Information, and Choice in Managed Care. New York, NY: The Commonwealth Fund.

Evans JH III. Involuntary Benchmarking and Quality Improvement: The effect of Mandated Public Disclosure on Hospitals. Journal of Accounting, Auditing and Finance 12(3):315-52.

Hibbard JH, Jewett JJ, Legnini MW, Tusler M. Marketwatch: Choosing a Health Plan: Do Large Employers Use the Data? Health Affairs 16(6):228-36.

Rainwater JA, Romano PS, Antonius DM. The California Hospital Outcomes Project: How Useful is California's Report Card for Quality Improvement. Journal on Quality Improvement 24(1):31-9.

Scanlon DP, Chernew M, Sheffler S, Fendrick AM. Health Plan Report Cards: Exploring Differences in Plan Ratings. Journal on Quality Improvement 24(1):5-20.

Bentley JM, Nash DB. How Pennsylvania Hospitals Have Responded to Publicly Released Reports on Coronary Artery Bypass Graft Surgery. Journal on Quality Improvement 24(1):40-9.

Jollis JG, Romano PS. Pennsylvania's Focus on Heart Attack—Grading the Scorecard. New England Journal of Medicine 338(14):983-7.

Longo DR, Land G, Schramm W, et al. Consumer Reports in Health Care: Do They Make a Difference in Patient Care? Journal of the American Medical Association 278:1579-84.

CAHPS® Preview Kit, prepared by the Agency for Health Care Policy and Research, U.S. Department of Health and Human Services.

New Jersey Department of Health and Senior Services. 1997. New Jersey HMOs: Performance Report.

New Jersey Department of Health and Senior Services. November 1997. Coronary Artery Bypass Graft Surgery in New Jersey 1994-1995.

Current as of May 1998

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Internet Citation:

Structuring Health Insurance Markets: Protecting Consumers and Promoting Competition. Workshop Summary, May 13-15, 1998, User Liaison Program. Agency for Health Care Policy and Research, Rockville, MD.

The information on this page is archived and provided for reference purposes only.

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