"Our findings show that less, not more, competition was associated with better health plan performance in several -- though not all--factors," says lead author Dennis Scanlon, associate professor of health policy administration at Penn State. "This finding seems counterintuitive, but it is possible that more HMO competition may result in providers finding it difficult to respond to competing quality initiatives. Also, competition may be focused more on driving down the plans' premiums, resulting in less attention to quality."
Scanlon; Shailender Swaminathan, University of Alabama at Brimingham; Michael Chernew, University of Michigan; James Bost, University of Arkansas for Medical Sciences; and John Shevock, Penn State, analyzed data from 341 HMO plans operating across various markets in the United States. They examined HMO enrollment and the most widely used measures of HMO performance: the Health Plan Employer Data and Information Set (HEDIS) and the Consumer Assessment of Health Plans Survey (CAHPS). They published their findings in the current (April) issue of the journal, Medical Care.
HEDIS measures the percentage of a health plan's eligible population that is compliant with recommended care guidelines such as immunization rates for children and teens; chronic illness care; and women's care (e.g. breast cancer screening rates). CAHPS includes members' opinions about their health care and services provided by their health plan and its affiliated physicians.
Other managed care programs, such as PPOs (Preferred Provider Organizations), should be studied as well, but similar data is not routine
Contact: Vicki Fong