Quality Health Care Measurements Sought

Article excerpt

NEW YORK - A growing number of large employers are asking health insurers and prepaid health-care plans to come up with numbers that measure not only costs but also the quality of the care that patients get.

Such measurements include how often patients must be readmitted to the hospital and the frequency with which patients switch doctors.

Important clients like the Xerox Corp., which has 66,700 American employees, are prodding health-care plans to expand and refine their quality measurement systems.

``We want demonstrable results,'' said Patricia M. Nazemetz, director of benefits at the company. Xerox plans to evaluate six health maintenance organizations that it recently signed up on the quality of care and whether patients say they are satisfied with their treatment.

``HMOs are businesses and they are market-driven,'' said James S. Doherty, president of the Group Health Association of America, a trade group in Washington. ``They get a lot of pressure from employers and unions and state governments. They want to have the systems and the processes to show them.''

``It doesn't count unless you can count it'' is a favorite saying of Leonard Abramson, president and chief executive of U.S. Healthcare, which is based in Blue Bell, Pa. His company already conducts an annual survey of its 909,000 adult members. It also audits doctors' records to see if they are performing basic tests and keeps track of how many patients switch doctors or drop out of the system.

``We understand what it takes to maintain good customer relations,'' Abramson said.

On another front, the Michigan Blue Cross and Blue Shield plan, which covers 614,000 people for the automobile industry, is developing quality guidelines for Michigan hospitals.

``We are looking at patient mortality rates and at readmissions to the hospital within 14 days,'' said Marianne Udow, a Michigan Blue Cross vice president. Under a new contract, Michigan Blue Cross offers ``incentives to make sure that the hospitals meet standards of appropriateness and quality, and disincentives if they don't,'' said Jack Shelton, the Ford Motor Co.'s manager of employee insurance.

Some health-care plans, notably Kaiser Foundation Health Plans, based in Oakland, Calif., and the Harvard Community Health Plan, in Boston, are adopting principles of quality management like those that swept the Detroit auto industry after Japanese car makers successfully adapted them from the ideas of W. …