Evaluating Managed Care Organizations: Better Performance Measures on the Way

Developing Criteria for Information Systems for Managed Care Organizations

From 1996 to 1997, the National Committee for Quality Assurance (NCQA) convened a work group of experts in performance measurement and information technology who examined the research literature, surveyed health plan information system capabilities, and interviewed 60 experts in the field.

NCQA, Washington, is the primary accreditation body of the managed care industry. It has played a key role in developing measurement standards to evaluate managed care organizations.

NCQA's efforts to generate more sophisticated measurements of health quality cannot be accomplished until health plans develop better information systems, most of which have been designed for billing and claims payment rather than to produce information on the quality of the health care provided.

Key Results

  • The work group produced a report, "A Road Map for Information Systems: Evolving Systems to Support Performance Measurement, " that outlines recommended steps that health plans will need to take to improve their information systems.

    The report includes the following conclusions and recommendations:
    • Current health plan information systems fall short in all areas necessary to a fully functioning "information framework."
    • Health plans can take a number of immediate steps to improve their information systems. These include:
      • Improve the use of currently available data.
      • Create an environment that rewards the automation of data.
      • Improve the quality of currently automated data.
    • In three to five years, a number of developments could make it possible to develop a full-blown information framework. These include:
      • Federal standards for the content and coding of medical records.
      • Federal standards for ensuring privacy.
      • Vendor software that automates patient records in compliance with standards.
      • Communication technology that makes it practical to share clinical data.

Funding

The Robert Wood Johnson Foundation (RWJF) supported the project with a grant of $137,000 between September 1996 and October 1997.