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Researchers examine the impact of health plan report cards on employee plan knowledge and choice

The Consumer Assessment of Health Plans Study (CAHPS®) is a 5-year research effort funded by the Agency for Healthcare Research and Quality (HS09218) to gather comparative information on health plan performance to help consumers make health plan choices. Employees provided CAHPS® reports on health plans offered by their employer were more aware of how the individual health plans performed in quality of care areas defined in CAHPS®, according to a new CAHPS® study. A second CAHPS® study revealed several major barriers that must be overcome before the private sector follows Medicare's lead in providing health plan comparisons on plan disenrollment (rate of enrollees leaving the plan and their reasons for leaving). The studies are summarized here.

Hibbard, J.H., Berkman, N., McCormack, L.A., and Jael, E. (2002, March). "The impact of a CAHPS® report on employee knowledge, beliefs, and decisions." Medical Care Research and Review 59(1), pp. 104-116.

The authors of this study interviewed employees of a large private employer with two separate campuses in Oregon. Employees at one campus received a CAHPS® report on four available health plans offered in their open enrollment materials (intervention group), while those at the other campus did not (control group). The CAHPS® report evaluated health plans in seven areas: ability to get care that is needed, ability to get care without long waits, how well doctors communicate, people's rating of their care, courtesy and respect of office staff, people's rating of their health plan, and customer service from the health plan.

Of the employees, 958 (656 intervention and 302 control) completed interviews both before and after open enrollment (pre- and postintervention). Only 53 percent of those in the intervention group remembered seeing the CAHPS® report. Those who saw the report had more information about the differences among the plans on the CAHPS® reporting topics and were more likely to believe these topics to be important in health plan choice than those who did not see the report. The findings suggest that employees who take time to review the materials are influenced at some level.

Carman, K.L., Daugherty, S., Harris-Kojetin, L.D., and Lubalin, J.S. (2002, March). "Private sector unlikely to follow Medicare lead in providing health plan disenrollment comparisons." Joint Commission Journal on Quality Improvement 28(3), pp. 115-126.

CAHPS® was developed to help consumers use information about the quality of health care plans to choose plans that best meet their needs. However, comparative information on private health plan disenrollment has not been developed or reported to date. Several major barriers must be overcome before the private sector follows Medicare's lead in providing health plan comparisons on plan disenrollment, conclude these researchers. They reviewed the research literature on plan disenrollment and how key groups might use disenrollment information, often assumed to be a proxy for plan dissatisfaction.

The researchers developed a disenrollment survey that covered areas of common interest to consumers, purchasers, and plans, but they could not recruit sponsors to test the collection and reporting of these data. This was due to four factors: technical challenges in developing appropriate samples (difficulty in tracking and identifying those who have left plans); wide variation in resources and capabilities of purchasers and plans; the perception that the costs of the survey outweighed the benefits of comparative information on disenrollment to the different sponsors; and the absence of strong demand from purchasers, regulators, or consumers to motivate plans to collect or report comparative information on disenrollment.

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