Disease management/managed care
Plan rates MDs on asthma care in new report
Plan hopes report will boost compliance
Health Net, California’s second-largest health plan, with 2.2 million members, released what is believed to be the first chronic disease-specific report card. When the report cards were mailed, most of the health plan’s 47 medical groups received grades of C or below for asthma care. To be precise, nine groups were rated above average, 32 were rated average, and six were rated below average.
Health Net surveyed 5,580 patients enrolled for a year or more identified through the plan’s pharmacy database as having received prescriptions for inhaled corticosteroids, beta-antagonists, or theophylline. Patients who received prescriptions for those medications but indicated they were not being treated for asthma were excluded from the survey.
The survey asked a series of questions about symptoms, treatment, knowledge of disease self-management, use of medical care, and satisfaction with care. It also measured the following eight areas of function on a scale of 0 to 100:
• perception of general health;
• physical functioning;
• social functioning;
• limitations due to physical conditions;
• limitations due to emotional conditions;
• limitations due to bodily pain;
• limitations due to mental health;
• limitations due to fatigue.
Among the study’s more disturbing findings are these:
• Only 72% of Health Net’s patients with severe asthma reported having a steroid inhaler and, of those, only 54% used it daily.
• Only 26% of patients with severe asthma reported having a peak flow meter and, of those, only 16% reported using it daily.
The National Asthma Education Program of the National Heart, Lung, and Blood Institute in Bethesda, MD, published its Guidelines for the Diagnosis and Management of Asthma in 1991. Although those widely disseminated guidelines clearly recommend the use steroid inhalers, the survey results indicate that most primary care physicians still are not routinely prescribing daily steroid inhaler use for patients with chronic asthma, notes Darius Jatulis, MS, senior statistician and manager of the quality initiatives division of Foundation Health Systems, Health Net’s parent company in Woodland Hills, CA.
"Our survey found that asthma specialists provided more thorough care than did primary care physicians in treating patients with asthma," adds Antonio P. Legoretta, MD, MPH, vice president of the quality initiatives division of Foundation Health Systems. "Patients who received care from an asthma specialist reported higher levels of compliance with prescribed management programs and better outcomes, as well as higher satisfaction with the treatment of their condition.
"We collected and published the data for several reasons," he says. "First, we wanted consumers and employers to be able to see which medical groups have a better track record for asthma care so that they could make provider decisions based on empirical data. Second, we wanted the report card results to motivate providers to improve their performance on asthma care."
Health Net mailed its Asthma Care Report Card to each of its medical groups and some employers who were especially concerned about asthma, says Jatulis. In addition, Health Net members can request a personal copy of the report.
The report card issues an asthma care score or ranking for each medical group. "It shows the asthma emergency department admission rate, hospitalization rates, peak flow meter use among the group’s asthmatic patients. It gives the rankings and results to decision makers in the health care marketplace," he notes.
In the meantime, Health Net took immediate action to improve asthma care for the roughly 5,000 members identified as having severe asthma. The plan sent peak flow meters and educational materials to each of its severe asthmatics. Health Net also hired a nurse educator to call a subgroup of its most severe asthmatics weekly to help remind them to use their peak flow meters and asthma medications.
Health Net plans to release similar report cards for other chronic conditions in the future, Jatulis says. "We’re already moving forward to do a similar report for maternity care."
Providers get a peek
Although Health Net mailed its Asthma Care Report Card to the plan’s medical groups, pro viders were given an opportunity to see preliminary findings and improve their scores before the final report was published, he says. "To help us get providers on board with this effort, we showed them their scores for a one- or two-year period prior to disseminating the scores. We gave providers the data first. We gave them the opportunity to respond, to react, and to test our measurement system. For example, depending on how they code for certain diagnoses or procedures, we might be measuring them unfairly."
Jatulis urges other health care organizations to start similar programs. "It’s well worth the effort it takes to do the surveys. It provides a document able, value-added service to your customers. It also offers your providers an opportunity to improve the care they deliver your members. We have a vantage point to look at different providers and examine variability. Individual pro vider groups may be working in a vacuum and be unable to see where they stand relative to their peers."
[See also: Legorreta AP, Christian-Herman J, O-Connor RD, et al. Compliance with national asthma management guidelines and specialty care. Arch Intern Med 1998; 158:457-464. Jatulis DE, Meng YY, Elashof RM, et al. Preventive pharmacologic therapy among asthmatics: Five years after publication of guidelines. Ann Allergy Asthma Immunol 1998; 811:82-88.]
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