BACKGROUND: In 1993, 27 corporate and government health care purchasers formed the Massachusetts Healthcare Purchaser Group (MHPG). Sixteen health plans submitted 1992 data on six clinical indicators-mental health inpatient days per patient and inpatient readmission, blood pressure screening, prenatal care, mammography screening, cesarean section (C-section) rates, and asthma admission rates-developed in an earlier pilot effort in response to the quality portion of MHPG's "Cost/Quality Challenge." DATA COLLECTION AND ANALYSIS: Detailed data specifications developed in the pilot to ensure uniform data collection were used, with a requested sample size for chart-reviewed measures of 220. A "clinically significant average range" was defined. Health plan performance was summarized for each indicator in a report released in March 1994. REPORTING OF CLINICAL INDICATOR RESULTS: For the six indicators, each plan had a unique pattern of variation from the average range. For prenatal care, mammography, and hypertension, many plans had opportunities for improvement. SURVEY OF PURCHASERS: Most of the purchasers MHPG surveyed in October 1994 about their assessment and use of the Cost/Quality Challenge Report found it useful. RESPONSES TO THE REPORT: To promote quality improvement activities among health plans, MHPG showed purchasers how to pursue performance issues with health plans, held a Best Practice Forum on C-section, and created a follow-up endeavor, the Coordinated Purchasing Initiative. SUMMARY AND CONCLUSIONS: In spite of potential problems posed by technical deficiencies, costs of data acquisition and quality efforts, and unintended effects of public reporting, purchaser/plan initiatives such as the Cost/Quality Challenge can provide valuable information to purchasers.
BACKGROUND: In 1993, 27 corporate and government health care purchasers formed the Massachusetts Healthcare Purchaser Group (MHPG). Sixteen health plans submitted 1992 data on six clinical indicators-mental health inpatient days per patient and inpatient readmission, blood pressure screening, prenatal care, mammography screening, cesarean section (C-section) rates, and asthma admission rates-developed in an earlier pilot effort in response to the quality portion of MHPG's "Cost/Quality Challenge." DATA COLLECTION AND ANALYSIS: Detailed data specifications developed in the pilot to ensure uniform data collection were used, with a requested sample size for chart-reviewed measures of 220. A "clinically significant average range" was defined. Health plan performance was summarized for each indicator in a report released in March 1994. REPORTING OF CLINICAL INDICATOR RESULTS: For the six indicators, each plan had a unique pattern of variation from the average range. For prenatal care, mammography, and hypertension, many plans had opportunities for improvement. SURVEY OF PURCHASERS: Most of the purchasers MHPG surveyed in October 1994 about their assessment and use of the Cost/Quality Challenge Report found it useful. RESPONSES TO THE REPORT: To promote quality improvement activities among health plans, MHPG showed purchasers how to pursue performance issues with health plans, held a Best Practice Forum on C-section, and created a follow-up endeavor, the Coordinated Purchasing Initiative. SUMMARY AND CONCLUSIONS: In spite of potential problems posed by technical deficiencies, costs of data acquisition and quality efforts, and unintended effects of public reporting, purchaser/plan initiatives such as the Cost/Quality Challenge can provide valuable information to purchasers.