Improving the Medicare Market: Adding Choice and Protections by unknow

Author:unknow
Language: eng
Format: epub
Tags: Health and Medicine : Healthcare and Quality
Publisher: NATIONAL ACADEMY PRESS
Published: 1996-11-04T00:00:00+00:00

Numerous studies have shown that whether an individual’s physician is in the health plan is an important determinant of choice. At least two of the sites included in these case studies (the California HIPC and CBIA) are in the process of developing a single provider directory—or superdirectory—for all health plans offered. The purpose of this is to identify all of the participating plans that a given provider participates with, so that enrollees can begin to make comparisons of those plans where they can access their current physician. Although this sounds like a relatively simple undertaking, it is in fact very difficult to ensure that the information in the superdirectory is current and accurate, especially in highly fluid markets like California. It is interesting to note that although Kaiser in California has exclusive relationships with physicians, it is enthusiastic about supporting the superdirectory. Kaiser believes that the greater percentage of women physicians in its panel provides a marketing edge.

Many purchasers have chosen to require health plans to submit the information for consumer choice materials by using common definitions and methodologies, such as HEDIS. In the case of consumer satisfaction surveys, there is a great deal of skepticism by consumers of health plan-generated consumer satisfaction data. Therefore, most purchasers cited here have opted to use a common consumer satisfaction survey instrument and to either administer the survey themselves or have these surveys administered by a qualified survey organization other than the health plans. This is relatively simple to do when the purchaser has direct access to the enrollment files.

The way that the comparative information is presented to seniors is also critical. Comparisons among plans, especially on issues related to quality and performance, can be technical, yet the differences must be easily grasped. Understanding such information is often difficult even for people who are faced with making such decisions regularly, such as federal employees. The experience of Southern California Edison strongly suggests that it is likely to be doubly difficult for seniors. Therefore, great attention should be given to the form of presentation. For example, use of graphics rather than dense text in type that is too small for some seniors to read may be necessary. (Considerable work in developing such easily understand comparative presentations has been done already.)

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