Ensuring health care quality: perspective from a member of NCQA's committee on performance measurement

Abstract

Using the California Public Employees' Retirement System (CalPERS) as an example, this paper illustrates how an employer can abandon the more traditional role of passive purchaser of health care benefits and become an active participant in cost containment and quality improvement in the health care industry. Through the use of the Health Plan Employer Data Information Set (HEDIS) 3.0 and other data collection and reporting methods, the communication gap between consumers, purchasers, health plans, and providers is narrowing. Increasingly, purchasers like CalPERS are becoming involved in quality improvement; they are recognizing the need to serve as intermediaries between consumers and health plans, to understand available data, and to disseminate that information to the consumer. The purchaser's impact on the health care community's business practices is growing. As a result, the collection and reporting of HEDIS data are now emerging as substantial fiduciary reporting responsibilities for health plans. This paper outlines a plan implemented in California for improving HEDIS data gathering and examines surveys, results, and problems encountered in improving and integrating health care information.