The role of performance measures for improving quality in managed care organizations

Objectives. To understand how managed care plans use performance measures f or quality improvement and to identify the strengths and weaknesses of curr ently used standardized performance measures such as the Health Plan Employ er Data and Information Set (HEDIS (R)) and the Consumer Assessment of Heal th Plans (CAHPS (R)) survey. Data Sources/Study Setting. Representatives (chief executive officers, medi cal directors, and quality-improvement directors) from 24 health plans in f our states were surveyed. The overall response rate was 58.3 percent, with a mean of 1.8 respondents per plan. Study Design. This exploratory qualitative research used a purposive sample of respondents. Two study authors conducted separate one-hour tape-recorde d telephone interviews with multiple respondents from each health plan. Principal Findings. All managed care organizations interviewed use performa nce measures for quality improvement but the degree and sophistication of u se varies. Many of our respondent plans use performance measures to target quality-improvement initiatives, evaluate current performance, establish go als for quality improvement, identify the root cause of problems, and monit or performance. Conclusion. Performance measures are used for quality improvement in additi on to informing external constituents, but additional research is needed to understand how the benefits of measurement can be maximized.