As more employers enroll workers in managed health care programs, measuring the quality and satisfaction of those plans becomes increasingly important. During the last 10 years, standards of care and provider performance have been promulgated by health plan accreditation organizations, most notably the National Committee for Quality Assurance.
But while health maintenance organizations are commonly reviewed for quality, preferred provider organizations, which enroll more Americans than any other health care delivery system, until recently had no standard method of quality measurement and reporting that allows for comparison of different PPOs.
The American Accreditation HealthCare Commission, a leading accreditor of PPOs, recently convened leaders of the PPO industry to discuss approaches to quality measurement and reporting in PPOs.
The American Accreditation HealthCare Commission is also meeting with employer representatives to discuss what information employers need from PPOs to enable them to evaluate quality and whether they are willing to pay higher administrative costs to obtain such information.
A small number of PPOs now report on their performance using a variety of tools, including both national and company-specific reporting tools. National performance assessment techniques used by PPOs include URAC accreditation and the NCQA's Consumer Assessment of Health Plans Survey. A few integrated PPOs are able to report modified HEDIS data. Many PPOs also report specific information requested by payers, such as: customer service, patient access to care, rates of complaints and grievances, and rates of utilization.
The American Accreditation HealthCare Commission convened the PPO industry leaders to discuss what, if any, standardized measures of performance are of value and are feasible to produce. The organization encouraged PPOs to consider the informational needs of payers, regulators and patients, and to identify a core set of information that could be reported in a standardized way. PPO leaders did not reach consensus on the need for standard measures of PPO performance. They noted that purchasers, regulators and patients have different demands for information.
The "PPO Leadership Meeting on Performance Reporting" is meeting with PPO leaders, consumer organizations, and employers to discuss strategies for improving information available about PPO quality.
More than a dozen PPOs and national organizations were represented at the meeting, including the American Association of Health Plans, the American Association of PPOs, Blue Cross Blue Shield Association, HealthLink and others.
The group heard presentations from the Agency for Health Care Policy and Research and several PPOs that report different quality measures. Garry Carneal, president and CEO of the American Accreditation HealthCare Commission. "We are very pleased that so many organizations sent representatives to this meeting. (The commission) has designed the "PPO Quality Initiative" to bring together ideas and data from all parts of the PPO system in order to improve the quality and efficiency of health care delivery."
At the meeting, Carneal asked the PPO leaders to comment on the value of adopting standardized tools to report on PPO performance. Although there was no unanimous agreement on most issues, several general themes emerged from the discussion.
--PPOs are extremely diverse in their structure and operations.
--State, federal, or employer-driven reporting requirements should account for this diversity.
--There are fundamental differences between PPOs and HMOs in financing and delivering health care. Employers, regulators, and consultants will need more education to understand fully these differences.
--Reports on PPO quality must be meaningful to payers and consumers.
--Quality reporting could include such areas as cost, access, satisfaction, provider credentialing, and management of grievances and complaints.
--Performance information should be of use to the PPO in improving PPO performance, as well as to external audiences seeking to evaluate PPO performance.
Karen Greenrose, President of the American Association of Preferred Provider Organizations said, "One of the major tasks PPOs face is communicating the important differences between PPOs and HMOs and showing the benefits of PPOs. PPOs offer a cost efficient delivery option with wide network access--this is the sort of thing we should address when we evaluate PPO performance."
In The American Accreditation HealthCare Commission 's earlier meeting with consumer organizations, the organizations expressed a strong desire for more information on PPOs. The representatives of consumer organizations expressed particular interest in learning about how PPOs operate and how they address specific patient care and customer service issues.
Federal Workers Comp Benefits More Generous that State Programs
Federal workers' compensation program benefits are generally more generous than benefits offered under most state workers' compensation programs, a 1996 congressional audit found:
Federal workers with dependents receive 75 percent of their salary, tax-free. Most states pay workers 66.7 percent of their salary whether or not they have dependents. Only seven states offer dependent benefits.
Maximum weekly compensation benefits for federal workers was $1,274. Top weekly benefits for state employees ranged from $253 in Mississippi to $817 in Iowa.
Federal workers with traumatic injuries can receive their regular pay for the first 45 days they are out of work. State workers must be out of work for three to seven days before they are eligible for wage-loss compensation.
Injured federal workers can choose their own doctors without restriction. Many states, including California, New York, Texas and Florida, require injured employees to choose doctors from a state list or let employers pick doctors.
Meanwhile, the U.S. Department of Labor has identified the most common injuries claimed by federal employees last year in the government's workers' compensation program. According to the Labor Department, these are:
--Strains: 24 percent.
--Back condition: 16.6 percent.
--Contusion or bruise: 12.4 percent.
--Laceration: 5 percent.
--Puncture wound: 3.3 percent.
--Stress: 2.9 percent.
--Fracture: 2.7 percent.
--Tendonitis: 2.7 percent.
--Carpal tunnel syndrome: 2.3 percent.
--Hearing loss: 1.3 percent.
Employers Can Do More to Encourage Retirment Savings
The American Savings Education Council is encouraging American workers to save now for retirement so they can avoid financial troubles.
According to the 1999 Retirement Confidence Survey, co-sponsored by the nonpartisan Employee Benefit Research Institute, ASEC, and Mathew Greenwald & Associates, only half of all workers have tried to determine how much they will need to save before they retire. In addition, many workers are unaware of the fact that the normal retirement age for full Social Security benefits is currently in the process of gradually increasing from age 65 to 67. This will mean fewer years of Social Security benefits for many individuals.
Employers can do their part by educating employees about the value of retirement savings, and making sure they take part in company-sponsored savings plans.
"In 1621, the Pilgrims were wise enough to put away food for the winter, " said Don Blandin, President of ASEC. "They beat the odds and so can you if you start saving for retirement today."
ASEC recommends these savings tools to help people get started:
Ballpark Estimate: An easy-to-use, one-page worksheet that helps you figure out how much you need to save for retirement. The Ballpark Estimate takes complicated issues like projected Social Security benefits and earnings assumptions on savings, and turns them into language and easy mathematics that you can understand.
Retirement Personality Profiler: Interactive tool that asks you a series of questions to determine which of five distinct retirement personalities you are: Planner, Saver, Struggler, Impulsive, or Denier. Based on your retirement personality, the Profiler provides tips on how you can do a better job of planning and saving for retirement.
Retirement Readiness Rating (R3): Measures how well you are preparing for retirement. Answer a series of 11 questions and receive a score ranging from 0-25, with a score of 25 indicating the best job of preparation. You will also receive advice on retirement planning based on your score.
The Ballpark Estimate worksheet, along with other interactive savings tools, is available at the ASEC web site: www.asec.org
The 1999 Retirement Confidence Survey (RCS) gauges the views and attitudes of working and retired Americans regarding retirement, their preparations for retirement, their confidence with regard to various aspects of retirement, and related issues. The survey is sponsored by EBRI, ASEC, and MGA.
Founded in 1978, EBRI's mission is to contribute to, to encourage, and to enhance the development of sound employee benefit programs and sound public policy through objective research and education. EBRI is a private, nonprofit, nonpartisan public policy research organization based in Washington, DC.
ASEC is a coalition of private- and public-sector institutions that undertakes initiatives to raise public awareness about what is needed to ensure long-term personal financial independence. ASEC's goal is to make saving; investing; and planning for different life stages, including retirement, a vital concern of Americans. ASEC is part of the Employee Benefit Research Institute Education and Research Fund (EBRI-ERF), a 501(c)(3) nonprofit, educational organization.
Mathew Greenwald & Associates, Inc. is a full-service market research and consulting firm specializing in all aspects of survey research design and analysis, focus group and one-on-one qualitative research; new product development and testing; marketing, communications and advertising research; attitude tracking surveys; market segmentation; and database marketing and analysis.
SOURCE American Savings Education Council