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Introduction to Health Services Research : A Self-Study Course
Module 2: Brief History of Health Services Research (Page 32 of 40)
Grading Health Maintenance Organizations
Move to HMO Accreditation Standards
Meanwhile, the managed care organizations struggle to control their expenditures by limiting services and referrals to specialists while providing quality care for their customers. The move for accreditation standards for HMOs has developed from the interests of the large purchasers (businesses) and the managed care companies themselves to evaluate the value of health care delivery in managed care.
HEDIS
 The HEDIS (Health Plan Employer Data and Information Set) report card system developed by the National Committee for Quality Assurance (www.ncqa.org) is an important measurement tool used to analyze the performance of the HMOs.
It is a set of performance measures that can be used by purchasers, physicians and consumers for evaluating and comparing the performance of health plans in promoting the health and well-being of their members. (NCQA began accrediting managed care organizations (MCOs) in 1991.
Performance measures were a response to the need for standardized, objective information about MCOs
These performance measures were a response to the need for standardized, objective information about MCOs). You can evaluate a health plan of your choice by "creating a report card at the NCQA site."
Health Services Researchers' Contribution to HEDIS
Health services researchers contributed to the definition of the data elements incorporated into HEDIS, including measures of consumer satisfaction and physician performance.
View Key Projects and Milestones in Health Services Research.
Discussion Questions
1. Why was there a need to develop standardized, objective information about managed care organizations in the early 1990s? Has this need continued into the present time? Discuss the importance of HEDIS and NCQA to health services researchers.
2. How have "report cards" affected your work? Have they affected patient care? Responsiveness of health care providers to their patient panel?
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