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First Health Plan Report Card
Slated for Fall Release
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Business New Haven
6/1/1998
By: BNH
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All 56 of the state's managed care organizations (MCOs) will be represented on the first Consumer Report Card on health plans issued by the state's Department of Insurance. Designed to provide impartial, user-friendly cross-plan comparative data, the report card will be published annually.
While an exact format has not yet been formalized, most of the data included on the report card has already been gathered by the state. According to Karen Smigel, a certified financial examiner with the insurance department, all organizations offering health plan products were required to submit their responses to the department's request for information by May 1. Smigel reports that contributing to the high level of reporting compliance was a $100-per-day penalty for late filings.
Issuance of an annual report card is one of the provisions of public act 97-99, “An Act Concerning Managed Care,” passed by legislators last year. It is the first attempt by government to offer consumers a method for evaluating plan features based on uniform measures of performance.
Says Smigel, “The report card is to assist people, particularly small to medium-sized employers, in making informed decisions on health coverage for their employees.” However, the insurance department will not be ranking plans against specific quality measurements.
Smigel encourages employers to contact her with input on what type of information or design elements would be most useful to their health benefits decision-making process. “Before finalizing the format of the report card, we will be test-marketing a prototype this summer with focus groups such as employers, individual consumers and health care professionals,” Smigel says. Employers interested in contributing to the development of the report card can contact Smigel at the state's Insurance Department: 860-297-3819.
Information on the report card will appear as unranked percentages. For example, some of the items MCOs must report on are:
n Provider turnover rate
n Percentage of primary care physicians in the network who are board-certified
n Rate of enrolled women age 52-69 years who had breast cancer screenings
n Rate of members having access to preventive and ambulatory health services
Other data being collected by the insurance department, but not necessarily included on the report itself, are a sample health care provider contract, a report on the plan's quality assurance plan, and various data submitted to the National Committee for Quality Assurance (NCQA), as well as a summary of complaints related to providers and delivery of care and actions taken.
Member satisfaction survey results won't make it onto this year's report card but will appear on future versions. Smigel points out a caveat for health plan buyers reviewing these report cards: the data is unaudited by the state. But MCOs are expected to observe the honor system, since misfilings will expose them to potentially costly penalties.
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