Conceptual and Technical Issues Regarding the Use of HEDIS and HEDIS-Like Measures in Preferred Provider Organizations

2001 ◽  
Vol 58 (4_suppl) ◽  
pp. 37-57 ◽  
Author(s):  
Lawrence C. Kleinman
Keyword(s):  
Performance Measurement ◽  
Health Maintenance Organization ◽  
Performance Measure ◽  
Functional Health ◽  
Health Maintenance ◽  
Manage Care ◽  
Preferred Provider Organizations ◽  
Information Set ◽  
Methodological Considerations ◽  
Key Aspects

Preferred provider organizations (PPOs) represent a diverse and complex set of arrangements among insurance entities, networks of physicians, network organizers, and purchasers. Opinions differ regarding the degree to which PPOs have responsibility to manage care and to measure and report key aspects of their performance to customers and the public. Technical and operational challenges to performance measurement currently limit public reporting, even when agreement exists that it is appropriate for PPOs to do so. The Health Plan and Employer Data and Information Set (HEDIS) is a health maintenance organization performance measure that could provide standards for PPO reporting. This article explores conceptual and methodological considerations regarding HEDIS and other performance measurement in PPOs and identifies failures of the current marketplace. While using some measures may be premature or inappropriate, there are significant opportunities to apply other measures now and, by doing so, to create a functional health care marketplace.

Conceptual and Technical Issues Regarding the Use of HEDIS and HEDIS-Like Measures in Preferred Provider Organizations

2001 ◽  
Vol 58 (1_suppl) ◽  
pp. 37-57
Author(s):  
Lawrence C. Kleinman
Keyword(s):  
Performance Measurement ◽  
Health Maintenance Organization ◽  
Performance Measure ◽  
Functional Health ◽  
Health Maintenance ◽  
Manage Care ◽  
Preferred Provider Organizations ◽  
Information Set ◽  
Methodological Considerations ◽  
Key Aspects

Preferred provider organizations (PPOs) represent a diverse and complex set of arrangements among insurance entities, networks of physicians, network organizers, and purchasers. Opinions differ regarding the degree to which PPOs have responsibility to manage care and to measure and report key aspects of their performance to customers and the public. Technical and operational challenges to performance measurement currently limit public reporting, even when agreement exists that it is appropriate for PPOs to do so. The Health Plan and Employer Data and Information Set (HEDIS) is a health maintenance organization performance measure that could provide standards for PPO reporting. This article explores conceptual and methodological considerations regarding HEDIS and other performance measurement in PPOs and identifies failures of the current marketplace. While using some measures may be premature or inappropriate, there are significant opportunities to apply other measures now and, by doing so, to create a functional health care marketplace.

Covered Lives in PPOs

2001 ◽  
Vol 58 (1_suppl) ◽  
pp. 16-33
Author(s):  
Dean G. Smith ◽  
Dennis P. Scanlon
Keyword(s):  
Performance Measures ◽  
Health Maintenance Organization ◽  
Organization Performance ◽  
Health Maintenance ◽  
Considerable Uncertainty ◽  
Performance Reporting ◽  
Lack Of Information ◽  
Preferred Provider Organizations ◽  
Enrollment Data ◽  
Collection And Management

Many measures of health plan performance require a count of covered lives to make the results meaningful. For both organizational and economic reasons, many preferred provider organizations (PPOs) do not collect enrollment data. Enrollment can be estimated, but current techniques for estimating enrollment are quite imprecise. Imprecision introduces considerable uncertainty into measures of PPO performance. Furthermore, uncertainty may exist even when enrollment data are available and complete because of challenges that PPOs face in linking enrollment data to claims and administrative data. Efforts to increase accountability through performance reporting may require PPOs to devote additional resources for the collection and management of enrollment data. The authors describe practices in tracking enrollment in PPOs and provide data to illustrate variations at both the regional and company levels. Variations in tracking dependents and lack of information on the demographic characteristics of PPO subscribers affect a PPO’s ability to produce standardized performance measures comparable to health maintenance organization performance measures.

Covered Lives in PPOs

2001 ◽  
Vol 58 (4_suppl) ◽  
pp. 16-33 ◽  
Author(s):  
Dean G. Smith ◽  
Dennis P. Scanlon
Keyword(s):  
Performance Measures ◽  
Health Maintenance Organization ◽  
Organization Performance ◽  
Health Maintenance ◽  
Considerable Uncertainty ◽  
Performance Reporting ◽  
Lack Of Information ◽  
Preferred Provider Organizations ◽  
Enrollment Data ◽  
Collection And Management

Many measures of health plan performance require a count of covered lives to make the results meaningful. For both organizational and economic reasons, many preferred provider organizations (PPOs) do not collect enrollment data. Enrollment can be estimated, but current techniques for estimating enrollment are quite imprecise. Imprecision introduces considerable uncertainty into measures of PPO performance. Furthermore, uncertainty may exist even when enrollment data are available and complete because of challenges that PPOs face in linking enrollment data to claims and administrative data. Efforts to increase accountability through performance reporting may require PPOs to devote additional resources for the collection and management of enrollment data. The authors describe practices in tracking enrollment in PPOs and provide data to illustrate variations at both the regional and company levels. Variations in tracking dependents and lack of information on the demographic characteristics of PPO subscribers affect a PPO’s ability to produce standardized performance measures comparable to health maintenance organization performance measures.

Development and Validation of an Immunization Tracking System in a Large Health Maintenance Organization

1993 ◽  
Vol 9 (2) ◽  
pp. 96-100 ◽  
Author(s):  
Thomas Payne ◽  
Susan Kanvik ◽  
Richard Seward ◽  
Doug Beeman ◽  
Angela Salazar ◽  
...  
Keyword(s):  
Tracking System ◽  
Health Maintenance Organization ◽  
Health Maintenance ◽  
Development And Validation

Performance measurement for supply chain management and quality management integration

2019 ◽  
Vol 27 (7) ◽  
pp. 2130-2147 ◽  
Author(s):  
Marcio C. Machado ◽  
Renato Telles ◽  
Paulo Sampaio ◽  
Maciel M. Queiroz ◽  
Ana Cristina Fernandes
Keyword(s):  
Supply Chain ◽  
Supply Chain Management ◽  
Quality Management ◽  
Performance Measurement ◽  
Performance Measures ◽  
Chain Management ◽  
Content Type ◽  
Theoretical Perspectives ◽  
Overall Performance ◽  
Key Aspects

Purpose The purpose of this paper is to present a conceptual framework for performance measurement (PM) for the integration of supply chain management (SCM) and quality management (QM). Design/methodology/approach A systematic literature review on SCM and QM was conducted to develop key performance measures related to six areas of integration between QM and SCM: leadership; continuous improvement and innovation; sustainability performance; stakeholders; information system; and management and strategic planning. Findings Supported by the literature concerning to supply chain quality management (SCQM) integration, a set of nine propositions about performance measures, that contribute to the integration of SCQM, were developed. Originality/value This study contributes to QM practices within a supply chain environment from an integrated perspective. Additionally, the propositions have significant implications from both managerial and theoretical perspectives. This study also extends the concept of supply chain quality integration by focusing on key aspects of PM that may help to improve the overall performance of the supply chain.

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