How Health Plans Partner with Providers Key to Quality

WASHINGTON, D.C. Health plans that rely on more organized physician groups score higher on a number of quality care measures, according to a study appearing in the August 2006 edition of the journal Health Services Research.

The study, “The Impact of Health Plan Delivery System Organization on Clinical Quality and Patient Satisfaction,” by Robin Gillies, Ph.D., et al., of the University of California, Berkeley School of Public Health found that the more organized a health plan’s delivery system is, the higher the plan performs on women’s health screening, immunization rates, heart disease screening, and diabetes screening.  Researchers analyzed 272 health plans nationwide using performance data from HEDIS® and CAHPS®.

The authors note that more organized physician groups tend to work in teams to target quality improvement, are more likely to have adopted health information technology to track patient care over time and have greater ability to align financial incentives with desired quality outcomes.

“Distinguishing between high-performing health plan delivery systems and mediocre ones is especially important in the current health care environment which is fraught with serious quality gaps, increasing rates of chronic disease, and mounting pressure from the government, employers and consumers for better quality and cost information on which to make informed decisions about health care,” Dr. Gillies said.

“We are pleased to see this study confirm what we have long known – delivery systems matter, and health plans that partner with organized delivery systems produce higher quality results,” notedJack Ebeler, President and CEO of the Alliance of Community Health Plans.

“Rigorous and comparable public reporting of quality data is essential.  As Congress and the Administration consider ways to better align Medicare payment with performance, this study reinforces what MedPAC and others have recommended: Health plans are the logical place to begin paying for performance because they can use their purchasing leverage to promote coordination among providers and quality improvement across the delivery system,” Ebeler added.
More information about the study is available here.

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About ACHP

ACHPis a leadership organization that brings together innovative health plans and provider organizations that are among America’s best at delivering affordable, high-quality coverage and care to their communities. Drawing on years of experience, members collaborate to share strategies and work toward solutions to some of health care’s biggest challenges. Their work is the foundation for ACHP’s advocacy on behalf of better health care nationally.  More information is available at www.achp.org.