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Show Addressed" (USGAO, 1994). They recommend that an independent third party verify data before publication, and that the federal government play a role in standardizing indicators and the formulas for calculating results in order to help overcome the barriers to the use of report cards. They felt that the barriers to using report cards are as follows: (1) inaccurate, misleading, or incomplete information sources; (2) indicators that may not measure quality; (3) little agreement on formulas for calculating performance results; and (4) no verification mechanisms in place to ensure the accuracy of reported results. The developers of report cards in Utah are aware of these challenges and are striving to overcome them. Agreement among experts on what a report card should include is far from complete in Utah, as well as in other parts of our country at this point, but progress is being sought through continuing collaborative activities such as Utah's Quality Technical Advisory Group efforts discussed below. Providers, researchers, and other experts have differing opinions about whether or not data sources are accurate and which indicators really measure quality. Audiences for Report Cards Performance measurements are done with different audiences in mind, and are prepared by different people or groups of people. For example, most health care organizations have a quality improvement/assurance effort underway to do a self-evaluation of their own efforts. This is true of hospitals, nursing homes, and managed care organizations, as well as others. In addition, external entities such as accrediting organizations (the Joint Commission on the Accreditation of Health Care Organizations, and the National Committee for Quality Assurance are examples), licensing authorities, and Medicare/Medicaid certification programs are involved in inspection of health care organizations. Their reports from inspections, which are designed to measure provider compliance to standards, rules, and regulations, can be considered report cards. Various stakeholders can derive different benefits from report cards. Corporate purchasers can select health plans offering the greatest value. Public health officials can evaluate progress toward meeting public health goals, and providers can determine with which health plans they want to associate. Providers also can benchmark their performance against that of other providers using report cards comparing various providers of similar services. Individual consumers can select providers and health plans by utilizing the information provided. Health care reform entities, such as Utah's Health Policy Commission, can use the report cards as one way to evaluate the effectiveness of Healthprint. The goal of Utah's health reform system is to promote ready access to effective care for a reasonable cost. Effective report cards could speak to the accomplishment of these goals by measuring performance related to the cost, quality, and access to care. Enhanced Use of Report Cards The use of report cards by the public and the comparison of various providers, as indicated earlier, is a new phenomenon. Originally this information was for use by the entities themselves, as well as accreditors and government regulators. Since the mid-1980s, corporate purchasers of health coverage for employees have been demanding information from hospitals and health plans about the quality of care they furnish. They want to be certain that what they are paying for has value. Now, with the health care reform movement so widespread, different consumers are asking for the same information, including the actual patients receiving care. Needless to say, health care providers have had some concerns about the outcomes of their services being shared and compared. This is a natural reaction. However, in this age of continuous quality improvement, one of the keys to success is the ability to minimize defensiveness, and to accept that knowing how one's organization measures up against others, and how satisfied one's consumers are, is an opportunity to gain valuable knowledge about areas on which to focus improvement efforts. What is the Utah Department of Health Doing about Report Cards? The Utah Department of Health is very much involved in the implementation of Healthprint and is supportive of health system improvement. It is working with the governor, the legislature, consumers, and interested public and private entities to promote and support appropriate access to quality care which is delivered in a cost-effective way. The Health Systems Reform Team and the Division of Health Care Financing are the main areas of the department working with report cards. "Healthy people in a healthy system" is the vision of the Health Systems Reform Team, a 152 member arm of the Department of Health. The Health Systems Reform Team is made up of the following entities: The Division of Health Systems Improvement (Bureau of Health Facility Licensure, Bureau of Program Certification and Resident Assessment, Bureau of Emergency Medical Services, Bureau of Utah's Health: An Annual Review 1995 13 |
