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A Yardstick for HMOs

July 06, 1998

The congressional debate over how to reform managed health care, which seemed so smooth a few months ago, is getting fractious. Last week, business leaders dismissed the House Republicans' newly issued HMO reform recommendations as "economically burdensome," while consumer advocates said the reforms were too tame to resolve the anguish of patients who feel ill-served by managed care.

There is one major reform, however, whose urgency is recognized by consumer advocates, medical professionals and business leaders alike: developing quality assessments for health care. People are bombarded with information from managed care providers--about their prescription plans, eyeglass plans, exercise classes--but none of it tells them how well the plan might perform when they fall seriously ill. What is their plan's success rate in heart attack care? How are the home health agencies that do so much of post-surgical care evaluated? How many hospital patients are assigned to each nurse? Not only is such information not released--HMOs cite competitive reasons--much of it is not even measured.

Better measurements and quality standards would also save money, like the hundreds of millions of dollars wasted annually on antibiotics for people who suffer from viral colds. "Look," the HMO doctor could tell a sniffling patient, "the standards tell us erythromycin will do you no good."

The managed care industry has begun evaluating how satisfied people are with their care, but the focus is on such measures as how long telephone callers wait on hold. A push for more could come from a federal panel recently convened by Vice President Al Gore, a so-called quality forum representing business, insurance, medicine and consumers.

Gore has charged the group with developing ways to help the public and employers assess whether managed care providers are delivering consistent, clinically effective health care.

The industry itself is in conflict on the quality issue. Most HMOs balk at releasing substantive medical quality statistics, but a chief industry lobbyist, Karen Ignagni, has called clinical quality information "the key to disease management . . . in the years ahead."

The plainer truth is that consumers can't assess different HMOs without quality information. The Gore panel can help establish what to measure and how to do it in a fair and evenhanded way.

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