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If you’re involved in managing the care of patients with chronic illnesses or providing disease management, you need to be measuring and assessing the effectiveness of your programs.
"If case managers and the organizations for which they work are worried about quality, they need to assess what they are doing and know how to benchmark their program against standards," says Dennis Scanlon, PhD, assistant professor of health policy and administration at Pennsylvania State University.
If you’re a case manager for a managed care insurer, you already may have data at your fingertips to give you a head start on determining where to focus your efforts.
Data from the Health Plan Employer Data and Information Set (HEDIS) and Consumer Assessment of Health Plans (CAHPS) survey can be invaluable to insurers as a way of monitoring quality of care, Scanlon says.
Although the performance measurement systems were developed to inform consumers and for use in accreditation, MCOs should find the measures useful for improving quality of clinical care, he says.
Scanlon is the lead author of a new study that looks at how managed care plans use performance measures to improve the quality of their members’ health care. Among his conclusions was that there is a significant variation among plans in terms of their ability to improve quality.1
If case managers are not already involved in your organization’s quality improvement efforts, they should get involved. "Case managers and disease management people are carrying out a lot of what is going on in quality improvement," he says.
And if you are involved in disease management or care of chronic patients at the population level, you need to be doing some sort of outcomes measurement, he says.
"If someone is not measuring, I would be skeptical about whether they are focusing on quality. One can’t know what to improve unless they measure it. The measurement tells you where you stand and points you in the direction of what should be improved," he adds.
Although you may be dealing with patients on a one-to-one basis, your disease management and chronic care quality improvement efforts should be measured on a population basis, he says.
That doesn’t mean that the physician or even the case manager won’t sometimes deviate from the plan on an individual basis, he adds.
"The point is that there is enough evidence that certain things need to be done with certain populations and they are not getting done," he says.
As long as health plans are collecting HEDIS and CAHPS data, they might as well put them to use; otherwise, they’re just spending money to collect data, Scanlon says.
He expressed doubt that very many consumers use the data in choosing a health plan. "There is no strong evidence that consumers are intrigued by this issue. Accrediting bodies have built some of HEDIS into accreditation scores, but only a handful of measures are involved in the scoring," Scanlon says.
He adds that he has not seen any strong evidence that Medicare and Medicaid HEDIS and CAHPS data are being used much used by government agencies, either.
However HEDIS and CAHPS data are invaluable to insurers as a means of monitoring the quality of care, Scanlon says.
Scanlon, D, Darby, C, Rolph, E, Doty, H "Use of Performance Information for Quality Improvement: The Role of Performance measures for Improving Quality in Managed Care Organizations" Health Service Research 36:3, July 2001, page 617 -639