Once Covered, How Good is the Care? by Robert Seifert

Having health insurance is unquestionably better than not for providing a pathway to health care, so the more than 100,000 people newly insured since last July by MassHealth and Commonwealth Care are already better off in that regard. But how much better off? How good is the access, and the care, they are receiving?

One set of measures answering those questions is in the annual MassHealth Managed Care HEDIS report issued by the Center for Health Policy and Research at UMass Medical School and available on the MassHealth website.

HEDIS stands for “Health Plan Employer Data and Information Set.” It is a widely used set of measures on which the quality of care delivered by managed care organizations nationwide is judged. MassHealth collects a subset of HEDIS measures from the four managed care organizations (MCOs) with which it contracts – the same four MCOs offering Commonwealth Care coverage – as well as from its Primary Care Clinician Program. A very high-level summary of the 2006 report is that the MassHealth plans as a group do well when compared to a national benchmark on measures of preventive care (immunizations, well-care visits, access to primary care practitioners), and somewhat less well against benchmarks for measures of appropriate care for managing the chronic diseases diabetes and asthma. The report also includes data on the utilization of mental health and substance abuse services.

There is considerable variation across health plans and across specific measures, so the summary statements above do not universally apply. There are also many other measures of quality, including member satisfaction, that are not in these reports. Nevertheless, the reports contain a lot more detail about these HEDIS measures, what they mean, and where opportunities for improvement lie, so they are definitely worth a click for the data nerds and for anyone who wonders what happens on the other side of enrollment.

Robert Seifert is Executive Director of the Massachusetts Medicaid Policy Institute.