Group ratings of "excellent," "very good," and "good" are derived from members' satisfaction with such factors as "thoroughness of exam," "skill of doctor," "interest in medical problems," and "amount of time with staff and physician." There are also several access issues. The reports list the percentage of members who report overall satisfaction with the group.
At press time, Health Net's first disease-specific report card was not on the Internet, but paper copies had been distributed to members. As terminology goes, the gloves come off with this document; groups are rated "above average," "average," or "below average" in their care — in this case, for asthmatics.
The asthma and other disease-specific report cards are intended to improve management of members' illnesses. Diabetes report cards will be issued this year, followed by depression, cardiovascular disease, and congestive heart failure.
Performance ratings are listed in percentiles — that is, relative, not raw, scores. The index lists compliance with a handful of HEDIS measures for commercial and Medicare patients. It also includes several indicators of patient satisfaction, based on responses from 100 patients in each medical group.
Marvin Gordon, M.D., chief medical officer for Monarch Health Care, an Orange County medical group, supports PacifiCare's efforts but has two concerns. Monarch's patient satisfaction was low, but then, he says, so was that of all groups in the area. "It's a fairly high socioeconomic class here, and I think we have demanding patients. Which is why a more meaningful comparison would probably be with our peers in south Orange County, not the entire state." Second, percentile rankings can be misleading. "People's tendency is to look at someone in the 50th percentile, and say, 'It's an average group.' On that scale, yes — but if the groups overall were very good, than that's still a good group."
Gordon Norman, M.D., vice president and plan medical director for PacifiCare of California, acknowledges those concerns, and says PacifiCare is refining the index with each successive release — the next of which is due in March. Percentile rankings were developed with simplicity in mind. "Some say we have aided and abetted a certain degree of learned helplessness in our population by sparing them the effort to really understand quality," he says. "I think the public is capable, but at the same time, they're not going to understand sophisticated statistics."
For the record, Norman adds that Quality Index is not a "report card."
"The term gets used in a variety of contexts," he says, "and we feel that conveying the best available information about quality should not be confused with judgmental sorting of good from bad among provider groups."