August 2003

Grant Results

National Program

Changes in Health Care Financing and Organization

SUMMARY

This 1996–1998 project, conducted by Jinnet B. Fowles, Ph.D., and researchers at the Institute for Research and Education in Minneapolis, evaluated how consumer-based reports cards affect institutional behavior in the health care market.

Staff designed the project to complement work currently underway to evaluate the impact of consumer information on consumer choice.

The project was part of the Robert Wood Johnson Foundation's (RWJF) national program Changes in Health Care Financing and Organization (HCFO) (for more information see Grant Results).

Key Findings
Researchers reported the following in a Findings Brief available on the HCFO Web site.

  • Within four years, the report card initiative had affected all five plans, albeit to differing degrees and with different specific changes.
  • Health plans cited the report card initiative as an incentive to direct attention toward quality improvement.
  • The health plans demonstrated a much stronger response to the report card initiative than did consumers.
  • Collecting and disseminating data on health plans is very costly, leading some in the field to question these expenditures, given the apparent lack of consumer interest.

Funding
RWJF provided a $112,649 grant to the project.

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THE PROJECT

Through a series of interviews and case studies, researchers at the Park Nicollet Institute for Research in Minneapolis evaluated the impact of a Minnesota-mandated health plan report card initiative that required the participation of all health plans enrolling state employees. The initiative called for the Minnesota Department of Employee Relations to survey managed care health plans every two years beginning in 1991.

Starting in 1992, the department released a biennial report card with detailed health plan information on such measures as out-of-pocket and premium costs, and data from a survey of plan enrollees that addressed plan quality, access and other consumer-provider relationship issues. The initiative also required plans to respond to the report cards with quality improvement "action plans." The program continued until 1996.

Researchers interviewed representatives of the Department of Employee Relations as well as senior executives of five health plans, including chief executive officers, senior medical directors, medical and administrative heads of quality assurance and improvement, and directors of marketing and of information systems. They also collected data from other sources to complete their case studies.

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FINDINGS

Researchers reported the following in a Findings Brief available on the HCFO Web site:

  • Within four years, the report card initiative had affected all five plans, albeit to differing degrees and with different specific changes. Structural changes implemented to improve their quality ratings included revamping key front-line positions, building support for quality improvement initiatives through internal measurement and monitoring, and redirecting clinic operations to focus on service quality. Some plans significantly increased the number and salaries of staff charged with addressing health care quality issues. However, the principal investigator cautions against attributing these positive outcomes to the report cards alone, noting that market characteristics, demographics and insurance regulations also play a role in any measurable health plan restructuring.
  • Health plans cited the report card initiative as an incentive to direct attention toward quality improvement. Factors affecting the magnitude and direction of an individual plan's response to the report card included:
    • The relationship between the plan and its provider network.
    • The degree of importance to the plan of state employee enrollment.
    • Plan size.
    • The amount of market competition the plan faced.
    • The plan's strategic business vision.
  • The health plans demonstrated a much stronger response to the report card initiative than did consumers. In fact, researchers considered the plans' response to be out of proportion to that of consumers. According to the principal investigator, plans placed very high value on their reputations, and this motivated their high level of response.
  • Collecting and disseminating data on health plans is very costly, leading some in the field to question these expenditures, given the apparent lack of consumer interest. The principal investigator noted "there is definitely benefit … currently it appears that the benefit is being realized at the institutional level and not the consumer level."

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GRANT DETAILS & CONTACT INFORMATION

Project

Evaluation of the Impact of Consumer Survey-Based Report Cards on the Health Care Marketplace

Grantee

Institute for Research and Education (Minneapolis,  MI)

  • Amount: $ 112,649
    Dates: June 1996 to March 1998
    ID#:  029202

Contact

Jinnet B. Fowles, Ph.D.
(612) 993-1949
fowlej@found.hsmnet.com

Web Site

http://www.hcfo.net

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Report prepared by: Mary Geisz
Reviewed by: Robert Crum
Reviewed by: Molly McKaughan
Program Officer: Nancy L. Barrand

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