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Can Physicians Diagnose Strengths and Weaknesses in Health Plans?
- Steven J. Borowsky, MD, MPH;
- Christine Goertz, DC; and
- Nicole Lurie, MD, MSPH
- Minneapolis Veterans Affairs Medical Center Minneapolis, MN 55417 University of Minnesota School of Public Health Minneapolis, MN 55455 Hennepin County Medical Center University of Minnesota School of Public Health Minneapolis, MN 55455 Requests for Reprints: Steven J. Borowsky, MD, MPH, Section of General Internal Medicine (111-0), Minneapolis Veterans Affairs Medical Center and the University of Minnesota, 1 Veterans Drive, Minneapolis, MN 55417. Current Author Addresses: Dr. Borowsky: Section of General Internal Medicine (111-0), Minneapolis Veterans Affairs Medical Center and the University of Minnesota, 1 Veterans Drive, Minneapolis, MN 55417.
In a competitive market, maintaining health care quality while containing costs requires that consumers and large purchasers of care have access to data on the cost and quality of care in health plans. Both individual health plans and more neutral bodies, such as the National Committee for Quality Assurance, have attempted to meet this demand for information by presenting plan-specific performance data in a “report card” format. Although the perspective of the consumer figures prominently in such reports, the perspectives of physicians, nurses, and other health professionals who deliver care are notably absent. Practicing health care providers are often the passive subjects of assessments of health plan quality; they may also implicitly express their opinions by, for example, deciding to stay with or leave a plan. However, providers seldom directly and systematically provide their perspective on the quality of the systems in which they practice. Formal assessment of providers' perspectives on quality in health plans may complement consumer surveys and other performance measures. We argue that these perspectives should be included in the assessment of the quality of health plans, and we discuss the association between provider satisfaction and providers' perspectives on quality of care.
Most health plan performance measures are intended to help the market function better by providing data for consumers and purchasers of care. Although many performance measures include information on cost, operating efficiency, quality of care, and consumer satisfaction, comparisons among plans have been difficult because of differences in data collection and analysis. Attempts have been made to standardize performance reporting requirements for health care organizations so that both purchasers and consumers can more directly compare the cost and quality of various managed care plans. The most widely used of these standardized performance measures is the Health Plan Employer …
