The Washington Post
March 8, 2001
by Bill Brubaker
Susan Pisano, a vice-president of the American Association of Health Plans:
“There is quite a lot of information that is available about the performance of America’s health plans.”
Comment: Unfortunately, most of the information currently available about the quality of health plans is of almost no value.
The majority of health plans are network model plans which contract with the health care providers at large. When quality parameters of different plans are measured, the same overlapping group of providers is being measured. When the same physician is being evaluated by each of the many plans with which he or she contracts, differences in sampling results have virtually no meaning.
The quality measurements designed by the health plan industry are usually designed to produce positive marketing messages. Patient satisfaction surveys are subject to the bias that, “Managed care is terrible overall, but I am very satisfied with my doctor and my health plan.”
Measurements of rates of favorable interventions, such as percentages of pap smears or retinal examinations in diabetics, have demonstrated that integrated staff model plans can improve the levels of these parameters
when compared to the loosely structured and overlapping network models. A deficiency of this approach is that providers are aware of the relatively few parameters that will be measured. The quality improvement programs are then often directed primarily to these very limited areas.
Other significant efforts are being made to improve quality assessment, and we will have better measurements. However, there is a much greater need to design a system that will promote quality in the first place. Although we have had many technological advances, measurements have shown that they have not had much impact in improving outcomes, compared to their cost, primarily because our system has been incapable determining and promoting the optimum use of this technology. Standards of practice vary tremendously between communities and between individual practitioners. Integrated staff model organizations have demonstrated that better standards of practice can be recognized and encouraged, and
errors, such as incompatible medications, can be greatly reduced. In this modern age of information technology we now have the opportunity to integrate our entire health care system. Structural design is the key
to quality. With a rational system in place, quality assessment can be elevated to a more noble purpose, and that is to provide a basis for continuing improvement in our health care structure.
As long as we continue with our fragmented health care system, quality improvement will remain only a dream. Let’s defragment our system by starting with a foundation of a publicly administered, universal risk pool. We have the resources for high quality care for everyone. Let’s start using our resources wisely.