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Health Care Performance or Insurance Performance?

Posted Aug 26 2008 4:09pm
Newsday has published on New York and New Jersey HMO performance. I think? Maybe it was health care providers.



The article discusses performance on measures by which HMO's are generally measured including prices and premiums, but then refers to prophylactic pre-op antibiotics, and Cesarean Section rates.



I may be a little dense, but I thought that health care providers did some of these things. I thought it was a doctor who had to write the order for antibiotics. I thought nurses verified and administered the medication: right drug, right time, right patient and all that. I thought that administrators were responsible for putting in place systems to ensure nobody slipped through the cracks. I'm not sure where a managed care organizations can influence appropriate process except by certifying and credentialing providers and dumping poor performers. Unless they have extra money to provide incentives to hospitals, doctors and nurses, and we know that's not happening.



The few examples of MCO's have the kind of control where they can be judged and measured this way are the staff model MCO's. Even though groups like Kaiser Permanente do not directly own their physician groups, they can certainly influence systems and incentives sufficiently to achieve quality goals better. At least theoretically; my reading of the literature is that it has been mixed.



Maybe that's why we're confusing performance measures that are appropriate for hospitals and staff model HMO's with those that are best for contracting agencies.



It is easy to get confused the wide variety of measures, which will not help physicians who are grumbling about how little quality is measured in quality measures. It also does not help those who feel that transparency is the key to health care reform. With the number of organizations that recommend quality measures proliferating, Scott Schreve's comments about confusion in P4P are exactly right .



Thanks to About Health Transparency for getting me started...
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