New Evaluation Methods Grade HMO Performance in Managing Chronic Diseases

Assessing health plans' care of enrollees with chronic conditions

From 1994 to 1997, staff at the National Committee for Quality Assurance worked on developing standard measures of HMO performance in caring for enrollees with four chronic illnesses: childhood asthma, diabetes, major depression and coronary artery disease.

The Washington-based National Committee for Quality Assurance is a nonprofit working to improve health care quality through measurement, transparency and accountability.

The project was part of the Robert Wood Johnson Foundation (RWJF) Chronic Care Initiatives in HMOs national program.

Key Findings

  • Working with a consortium of interested purchasers, consumers, health plans, and public-sector individuals, project staff selected four conditions for evaluation: childhood asthma, diabetes, major depression and coronary artery disease.

  • The National Committee for Quality Assurance funded six applied research centers in HMOs to develop quality measures for the four conditions.

  • The research centers refined key aspects of the performance measurement process, including:

    • Protocols for identifying patient samples.
    • Strategies for potential case-mix adjustment.
    • Definition of appropriate processes of care.
    • Specification of relevant patient-centered outcomes.

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