Improving the process through which health plans and providers exchange performance-related mammography data.
The ability of health plans to bring about quality improvement is limited by the fact that physician networks are highly differentiated, with physician groups participating in many plans and plans contracting with many physician groups. The primary purpose of our study was to investigate the problems in the current system of quality monitoring by managed-care organizations (MCOs) at a large integrated health care delivery system (Montefiore Medical Center) and to develop ways of addressing these problems through collaboration among MCOs. The project began by mapping the current system for collecting, reporting, and using performance data to improve performance, using breast cancer screening as an example. We found that neither health plans nor providers were satisfied with the current system. From the perspective of the health plans, the current quality monitoring was costly and, more important, was not yielding appreciable increases in screening rates. From the providers' perspective, multiple health plan requests for chart pulls and other data collection activities cost them substantial amounts of time and money and generated multiple mailings of educational materials and reports, but rarely supplied meaningful information about their performance. From the perspective of the hospital, the current procedure of reporting from MCO to provider or center bypassed the institution's own quality monitoring and management structure and thus limited the institution's ability to assist in quality improvement. This study clearly showed the importance of collaboration among plans at a given provider site. Specifically, it pointed to the need for provider-oriented reporting of data, rather than plan-oriented reporting, to give physicians numbers that they believe. It also showed the need to engage the institution's own quality-management system to assist in bringing about improvements.
Fairbrother
Gerry
G
Division of Health and Science Policy, New York Academy of Medicine, New York, NY 10029-5293, USA. gfairbro@nyam.org
Luciano
James
J
Park
Heidi L
HL
D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration / Q000592:standards*; D005260:Female; D006302:Health Services Research; D006801:Humans; D033181:Information Dissemination; D019451:Information Management; D007345:Insurance Claim Review; D008327:Mammography / Q000706:statistics & numerical data*; D008329:Managed Care Programs / Q000458:organization & administration / Q000592:standards*; D008403:Mass Screening / Q000706:statistics & numerical data*; D009519:New York City; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care