For health plan business, collect outcomes data
Outcomes will sell your agency
Managed care organizations want it. So do commercial payers. The Health Care Financing Administration (HCFA) in Baltimore now requires it. And if you don’t start collecting it, you might be kissing any health plan business goodbye.
Effective in January, HCFA requires that health plans serving Medicare beneficiaries will be required to submit outcomes data on Health Plan Employer Data and Information Set (HEDIS) 3.0 standardized performance measures relevant to Medicare. HEDIS is a collection of some 71 performance measures that standardize health plan measurement in eight areas of performance: effectiveness of care, access/availability of care, member satisfaction, health plan stability, use of services, cost of care, informed health care choices, and health plan descriptive information. Many large employers rate health plans based on HEDIS "report card scores." The National Committee for Quality Assurance (NCQA) in Washington, DC, is the accrediting body for health plans and the architect for HEDIS. The nation’s largest private and public purchasers of health care have endorsed HEDIS 3.0 and have signaled that all health plans whether they care for commercially insured populations or those covered by Medicare or Medicaid begin collecting HEDIS 3.0 data in 1997.
What does this mean for you? Although HCFA’s requirement asks for data only on the provider level and for Medicare patients, private duty home health agencies that want health plan business may eventually be asked to provide HEDIS outcomes data, some home care and HEDIS development committee sources predict.
Even if not using the HEDIS performance measures, home care experts say private duty agencies will need to show health plans that they can report patient satisfaction by:
• patient;
• payer;
• type of service;
• diagnosis.
"Whenever managed care organizations say you have to meet those requirements or industry standards to have a contract with them, agencies definitely would have to meet [those requirements]," says Donna L. Franks, RN, MS, CCM, home care consultant for HomeCare Resource Associates, Des Plaines, IL. (For more about the importance of collecting outcomes data, see p. 14.)
(Editor’s note: As of the end of November, NCQA had reviewed 268 health plans, including 21 whose decisions were still pending at that time. The total number of health plans is estimated to be about 630.)
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