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L Gregory Pawlson

Publications and source records attributed to L Gregory Pawlson.

5 recordsLinked to original sources
PubMed2003

Standardized health plan reporting in four areas of preventive health care.

PURPOSE: This paper discusses first-year reporting by commercial managed care organizations (MCOs) of new measures in the 2000 Health Plan Employer Data and Information Set (HEDIS). The four measures include screening for chlamydia in young women, controlling blood pressure to <140/90mmHg in patients with hypertension, prescribing appropriate medications for persons with asthma (treatment adherence), and providing counseling to women about managing menopause (survey measure). METHODS: In 2000, some 384 commercial MCOs submitted HEDIS results to the National Committee for Quality Assurance (NCQA). Results of the four new HEDIS measures were linked with audit reports and other health plan data-reporting characteristics collected by NCQA. Performance variables were stratified by MCOs' willingness to report their results publicly, size of enrollment, performance on other (non-first year) HEDIS measures, and data collection issues. RESULTS: The mean average performance on the four measures was lowest in chlamydia screening in women (16% for ages 21 to 26 years) and highest for use of appropriate medications for people with asthma (59% for ages 18 to 56 years). The mean average of controlling high blood pressure was 39%. Scores on the management of menopause (MoM) measure ranged from 33.7 (for rating of information) to 72.6 (for exposure to counseling). CONCLUSIONS: The initial MCO baseline rates reported here suggest that much work is needed to improve the quality of care in these areas. Plan characteristics shown to be associated with higher performance on existing HEDIS measures do not predict performance on the new measures. In addition, fewer plans reported on the new measures than on established HEDIS measures. To ensure continued improvement in chlamydia screening in women, controlling high blood pressure, use of appropriate medications for people with asthma, and MoM, incentives for tracking and reporting on these health issues must be explored.

Adolescent↗
PubMedDate not supplied

Professionalism, regulation, and the market: impact on accountability for quality of care.

This paper examines the interplay of professionalism, regulation, and the market in shaping accountability on the part of hospitals, physicians, and health plans. We pay particular attention to the role of accreditation. We review the development of accountability and examine its recent evolution in the context of changing information technology, consumer demands, the decline of the staff- and group-model HMO, and the reemergence of health care cost inflation. The market is emerging as the dominant influence on accountability; this development will require changes in the roles and structure of regulation, professionalism, and accreditation in assuring accountability.

Accreditation↗