title: Health plan quality-of-care information is undermined by voluntary reporting.
abstract: BACKGROUND
  Most health services in the United States are delivered by managed care organizations (MCOs). Publicly available, plan-specific performance information is required to adequately assess healthcare quality provided. Using women's health indicators, we compared performance results for MCOs and evaluated whether those MCOs that publicly report quality-of-care (QOC) results demonstrate better QOC than those plans that restrict public access to data.
  
  
  METHODS
  Data from the Health Plan Employer Data and Information Set (HEDIS) for commercial MCOs in 1998 were analyzed for women's QOC indicators. Plan-specific, regional, and national performances were analyzed and results compared to established benchmarks. Public-reporting plans were compared to plans that restrict access to QOC information. Linear regression was used to identify determinants of health plan performance including public release of information.
  
  
  RESULTS
  Commercial MCOs had wide variations in QOC indicators and, on average, failed to attain national health goals for most women's health indicators analyzed. Plans that restricted public access to QOC information had poorer performance than those that did not (p<0.05). Results suggest that whether a plan publicly releases its performance information is highly associated with health plan performance even after taking into account other factors.
  
  
  CONCLUSIONS
  The voluntary aspect of reporting and the ability of health plans to restrict public access is allowing poorer performing health plans to escape public scrutiny. Variations in QOC have clinical significance and, if publicly available, would enable individuals to select high-quality healthcare products. The ability of health plans to restrict public information is not consistent with the 1973 Health Maintenance Organization Act requiring public information on health plan quality. A national strategy to ensure that QOC information is available on all healthcare systems is past due.
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. thompsonjosephw@uams.edu
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Thompson
authors.forename: Sathiska D
authors.initials: SD
authors.lastname: Pinidiya
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Ryan
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: McKinley
authors.forename: Shannon
authors.initials: S
authors.lastname: Alston
authors.forename: James E
authors.initials: JE
authors.lastname: Bost
authors.forename: Jessica
authors.initials: J
authors.lastname: Briefer French
authors.forename: Pippa
authors.initials: P
authors.lastname: Simpson
mesh_terms: D000328:Adult; D003625:Data Collection / Q000379:methods*; D005260:Female; D006801:Humans; D008329:Managed Care Programs / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D011787:Quality of Health Care; D014481:United States; D014932:Women's Health Services / Q000706:statistics & numerical data*