Article    Table of Contents                    Full Text of this article Free    Figures/Tables List  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Spoeri, R. K.    Ullman, R.    Related Articles in PubMed    PubMed Citation    PubMed

QUALITY MEASUREMENT AND IMPROVEMENT

Measuring and Reporting Managed Care Performance: Lessons Learned and New Initiatives

Randall K. Spoeri, PhD, and Ralph Ullman, MBA, MS

15 October 1997 | Volume 127 Issue 8 Part 2 | Pages 726-732

Performance measurement has become increasingly popular in the health care delivery system of the United States. Until recently, the hospital was the most commonly scrutinized setting. With the expansion of managed care and the resulting compilation of large administrative databases, interest in performance measurement beyond the hospital setting has increased considerably. In particular, the performance of health maintenance organizations is now being assessed and reported publicly. The performance of individual physicians is also garnering considerable attention.

This paper summarizes some of the many developments in performance measurement in managed care. The Health Plan Employer Data and Information Set (HEDIS) is described in the context of the national Report Card Pilot Project and with respect to local report card projects emerging around the United States. The lessons learned are identified, particularly with respect to external auditing of HEDIS data. Finally, the new initiatives of physician profiling and outcomes reporting are discussed.

Author and Article Information

From NYLCare Health Plans, Inc., New York, New York.
Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled "Measuring Quality, Outcomes, and Cost of Care Using Large Databases: The Sixth Regenstrief Conference." To see a complete list of the articles included in this supplement, please view its Table of Contents.
Requests for Reprints: Randall K. Spoeri, PhD, NYLCare Health Plans, Inc., One Liberty Plaza, Suite 8-6, New York, NY 10006.
Current Author Addresses: Dr. Spoeri and Mr. Ullman: NYLCare Health Plans, Inc., One Liberty Plaza, Suite 8-6, New York, NY 10006.
Current Author Addresses: Dr. Spoeri and Mr. Ullman: NYLCare Health Plans, Inc., One Liberty Plaza, Suite 8-6, New York, NY 10006.

This article has been cited by other articles:

				A. L. Rosenberg, T. P. Hofer, C. Strachan, C. M. Watts, and R. A. Hayward Accepting Critically Ill Transfer Patients: Adverse Effect on a Referral Center's Outcome and Benchmark Measures Ann Intern Med, June 3, 2003; 138(11): 882 - 890. [Abstract] [Full Text] [PDF]

				F. Ahmed, E. E. Elbasha, B. L. Thompson, J. R. Harris, and V.-P. Sneller Cost-Benefit Analysis of a New HEDIS Performance Measure for Pneumococcal Vaccination Med Decis Making, October 1, 2002; 22(5_suppl): S58 - S66. [Abstract] [PDF]

				E. A. Rider and J. M. Perrin Performance Profiles: The Influence of Patient Satisfaction Data on Physicians' Practice Pediatrics, May 1, 2002; 109(5): 752 - 757. [Abstract] [Full Text] [PDF]

				E. H. Morreim Quality of Life: Erosions and Opportunities Under Managed Care J. Law Med. Ethics, June 1, 2000; 28(2): 144 - 158. [PDF]

				S. H. Taplin, W. E. Barlow, E. Ludman, R. MacLehos, D. M. Meyer, D. Seger, D. Herta, C. Chin, and S. Curry Testing Reminder and Motivational Telephone Calls to Increase Screening Mammography: a Randomized Study J Natl Cancer Inst, February 2, 2000; 92(3): 233 - 242. [Abstract] [Full Text] [PDF]

				M. Alexander, I. Tekawa, E. Hunkeler, B. Fireman, R. Rowell, J. V. Selby, B. M. Massie, and W. Cooper Evaluating Hypertension Control in a Managed Care Setting Arch Intern Med, December 13, 1999; 159(22): 2673 - 2677. [Abstract] [Full Text] [PDF]

				M. H. Kollef Improving Outcomes in the ICU Setting : Are We Effectively Using all of the Information That Is Potentially Available to Us? Chest, June 1, 1999; 115(6): 1490 - 1492. [Full Text] [PDF]

				R. Favaloro A Revival of Paul Dudley White : An Overview of Present Medical Practice and of Our Society Circulation, March 30, 1999; 99(12): 1525 - 1537. [Full Text] [PDF]

				A. G. Mainous III and J. Talbert Assessing Quality of Care via HEDIS 3.0: Is There a Better Way? Arch Fam Med, September 1, 1998; 7(5): 410 - 413. [Abstract] [Full Text] [PDF]