Health Care Quality: Implications of Purchasers' Experiences for HCFA

Pursuant to a congressional request, GAO determined how large purchasers use quality-related data to seek or promote better quality of care and lessons that can be learned from their experiences for the Health Care Financing Administration (HCFA).

GAO noted that: (1) after collecting and making use of quality-related data, the purchasers GAO studied reported that in addition to cost savings, they saw improvements in access to care and health plan services, as well as in employee satisfaction with health plan performance; (2) they realized such improvement by identifying opportunities to use quality-related data in selecting health plans, monitoring health plan performance, developing quality improvement initiatives with plans and taking other actions, and providing information on health plans to their employees; (3) while HCFA is a unique purchaser of managed care--by virtue of the size of the Medicare program and the freedom of choice provided to beneficiaries--a number of private purchasers' quality of care strategies could be relevant to HCFA's administration of the Medicare program; and (4) major lessons from large purchasers' experiences relate to the importance of: (a) educating employees as to the meaning of quality-related measures when providing comparative information on health plan quality; (b) using collaborative- and compliance-oriented approaches to achieve improvements in plan performance; and (c) continually looking for additional opportunities to make use of quality-related data, such as developing standards and benchmarks for plan performance.