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MANAGING MANAGED CARE: QUALITY IMPROVEMENT IN BEHAVIORAL HEALTH
FACCT evolved during 1995 because of the interests of several major private and public purchasers, as well as consumer groups, for public-measurement systems that account for outcomes related to quality such as patient satisfaction, health-related quality of life, and functional status. Their wish to expedite the development of outcomes and methodologies and systems was spurred by Paul Ellwood's long-standing promotion of the national goal of a patient-centered and integrated outcomes management system. To date, FACCT has released measurement methods for a number of conditions (e.g., diabetes, asthma, and breast cancer) and is planning the development of similar tools and pilot programs for behavioral health conditions such as depression. The application and evolution of FACCT methods will be influenced by the amount of funding that is available and how meaningful the collected information will be to consumers and purchasers.
Many purchasers are now prodding their contracted managed care organizations and a few are requiring their contracted managed care organizations to collect and publicly report their Health Plan Employer Data and Information Set (HEDIS) results. This and other public report cards constitute a major trend in health care and are being actively supported by consumers who want meaningful data on which they can make personal health care and health plan selection decisions. Managed care organizations are concerned about the risk adjustment problems with some measures, the cost of collecting data, the high-stakes business risks that can follow questionable performance, and the plethora of reporting requirements that are being imposed under multiple reporting systems. The evolution of other potentially large systems, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), NCQA, Utilization Review Accreditation Commission (URAC), and Council on Accreditation of Services for Families and Children (COA), adds to their concerns about their abilities to simultaneously meet the market's demands for improved accountability and lower premiums.
From these early efforts to establish quality standards and tools that can be used to measure quality, several views are emerging:
Standards and measures for quality-related components of structure (e.g., state licensure and national accreditation), process (e.g., provider adherence to clinical policies), and outcomes (e.g., level of functioning and patient satisfaction with clinical care) are relevant to conclusions about quality.
Routine and consistent measurement of specific health conditions and illnesses should be conducted for individuals in a health plan and for the population.
Risk adjustments, based on individual and population variables, are critical in reaching conclusions about the process and outcomes of health care.
Health status (physical functioning, role capacities, and objective and