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Context: Many states have turned to commercial health plans to serve Medicaid beneficiaries and to achieve cost-containment goals. Assumptions that the quality of care provided to Medicaid beneficiaries through these programs is acceptable have not been tested., Objective: To compare the quality of care provided to children and adolescents in commercial and Medicaid managed care in the United States., Design, Setting, and Population: Using 1999 data collected through the Health Plan Employer Data and Information Set, we examined reported quality-of-care indicators for children and adolescents. Results from 423 commercial and 169 Medicaid plans were compared. Matched pairs analyses were performed using data from each of the 81 companies serving both populations to control for corporate differences. Correlation coefficients and regression procedures were used to examine observed variations in health plan performance., Main Outcome Measures: Quality indicators including prenatal care, childhood immunizations, well-child visits, adolescent immunizations, and myringotomy and tonsillectomy rates., Results: Using standard indicators of clinical performance, children and adolescents enrolled in Medicaid received worse care compared with their commercial counterparts. For most of the 81 health plans serving both populations, Medicaid enrollees had statistically significantly (P<.001) lower rates than commercial plans for clinical quality indicators (eg, childhood immunization rates of 69% vs 54%); for clinical access indicators (eg, well-child visits in the first 15 months of life, 53% vs 31%); and for common procedures (eg, myringotomies for children aged 0-4 years, 35 vs 2 per 1000 members). Conversely, some plans demonstrated equal and high-quality care for both populations. Regression models failed to identify consistent plan characteristics that explained the observed differences in quality of care., Conclusions: Most commercial health plans do not deliver high-quality care on a number of performance indicators for children enrolled in Medicaid. Policy makers and the public need plan-specific quality information to inform purchasing decisions.

Purpose: This paper discusses first-year reporting by commercial managed care organizations (MCOs) of new measures in the 2000 Health Plan Employer Data and Information Set (HEDIS). The four measures include screening for chlamydia in young women, controlling blood pressure to <140/90mmHg in patients with hypertension, prescribing appropriate medications for persons with asthma (treatment adherence), and providing counseling to women about managing menopause (survey measure)., Methods: In 2000, some 384 commercial MCOs submitted HEDIS results to the National Committee for Quality Assurance (NCQA). Results of the four new HEDIS measures were linked with audit reports and other health plan data-reporting characteristics collected by NCQA. Performance variables were stratified by MCOs' willingness to report their results publicly, size of enrollment, performance on other (non-first year) HEDIS measures, and data collection issues., Results: The mean average performance on the four measures was lowest in chlamydia screening in women (16% for ages 21 to 26 years) and highest for use of appropriate medications for people with asthma (59% for ages 18 to 56 years). The mean average of controlling high blood pressure was 39%. Scores on the management of menopause (MoM) measure ranged from 33.7 (for rating of information) to 72.6 (for exposure to counseling)., Conclusions: The initial MCO baseline rates reported here suggest that much work is needed to improve the quality of care in these areas. Plan characteristics shown to be associated with higher performance on existing HEDIS measures do not predict performance on the new measures. In addition, fewer plans reported on the new measures than on established HEDIS measures. To ensure continued improvement in chlamydia screening in women, controlling high blood pressure, use of appropriate medications for people with asthma, and MoM, incentives for tracking and reporting on these health issues must be explored.

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.

Objective: To assess reported results of health care quality for children and adults in managed systems of care and to determine if variations exist between reported quality results for adults and children within the same plan., Methods: We utilized Consumer Assessment of Health Plan Survey results reported from 424 managed care plans to the National Committee for Quality Assurance in 1999. Responses from 218 530 adults (515 per plan, 424 plans) and 55 081 parents of children 0-12 years of age (304 per plan, 181 plans) were available. Restricting analyses to the 178 plans reporting both adult and child results, we performed matched-pairs analyses to test the hypothesis that child results would be the same as their adult counterparts within the same plan. Regression methods were employed to test for potential demographic differences explaining observed differences., Results: Within the same plan, reported results for care provided by specialists and primary care physicians to adults and children in the same plan revealed marked variation, including rating of doctor (Spearman correlation coefficient, r(S) =.504) and rating of specialist (r(S) =.326). Conversely, assessments of activities related directly to health plan activities showed little variation, including rating of health plan (r(S) =.850) and claims processing (r(S) =.857). Differences in demographic characteristics between adults and child survey respondents do not appear to explain observed variations., Conclusions: Separate quality of care assessments for adults and children within the same managed care system identify significant differences in reported quality. Having health plan quality information about adult care does not serve as a proxy for needed information on children, particularly the care related to primary care and specialist providers. Areas of health plan assessment common to both adults and children (eg, claims processing) could be replaced with more targeted assessments of importance to parents and purchasers (eg, children with chronic conditions).

Objective: This study examined the rates and correlates of mental health care performance measures in the Health Employer Data and Information Set (HEDIS)., Method: For all 384 health maintenance organizations (HMOs) participating in the HEDIS program of the National Committee for Quality Assurance during 1999, analyses examined the rates of compliance with five mental health care performance measures and their association with general medical care quality, public reporting, and HMO finances., Results: The mean rate of mental health care performance was 48.0%, compared with 69.2% for non-mental-health care domains. In multivariate models adjusted for plan characteristics, scores for worse quality of non-mental-health domains, failure to report data publicly, and low medical-loss ratio (proportion of revenues spent on clinical care) all predicted poor mental health care performance., Conclusions: Better general medical care, transparency of reporting, and commitment of fiscal resources to clinical care predicted better mental health care performance for U.S. HMOs.

Presents an evaluation of the quality of managed care in the United States on October 1st, 1997, by the National Committee for Quality Assurance. Type of information included in the evaluation; How the data was collected; What the results suggested; How this information will be used.

Presents a letter from the authors of a study called "Quality of care for children in commercial and Medicaid managed care" in reply to letters to the editor concerning that study.