HMO quality praised - Short Takes - Brief Article

Physician Executive, July-August, 1999

Health maintenance organizations have received some good news on the quality front. The Alliance of Community Health Plans notes that the Dartmouth Atlas of Health Care found that Medicare beneficiaries in managed care plans received better preventive screening services for major conditions than other beneficiaries enrolled in the traditional Medicare program.

According to the Atlas only 28 percent of women aged 65 to 69 had mammograms during the study period. Best practice protocols call for women in this age group to have a mammogram every two years. In contrast, according to Ed Marine, MD, a senior health care consultant at HealthCare Plan in Buffalo, New York. women receiving their care From physicians participating in not-for-profit and provider-based health plans averaged more than 80 percent."

Marine says that the reason why these plans have done better is no mystery. The best of them have always measured performance and provided regular feedback to participating physicians, making it possible for them to improve quality He contends that health plans that are determined to partner with physicians have time and time again demonstrated superior performance in health care services. Mammograms were by no means the only difference that was found. Health plans scored higher for their preventive efforts in a number of areas, such as eye exams for patients with diabetes.