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
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
``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
``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
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. …