New HMO Rules: Outcomes Disclosure

New standards being introduced throughout the USA will have managed care plans disclose more information about their care of patients, in the form of outcome measures. Much of the pressure for these results has come from some of the larger purchasers of medical care and consumers groups which want strong evidence that their members are getting proper care.

The outcome measures will not include much information about how patients did, but will rather deal with which medical procedures the health plans follow. Comparisons of patients' health status would be unfair, say the health maintenance organizations, because plans may have more patients who are younger or have milder forms of disease, or because some plans are too small to have significant statistics. The cost of the outcomes measures is also an issue for the HMOs, which say they already spend heavily to measure patient satisfaction and to see if the right procedures are being followed.

While HMOs cannot be forced to report patient-care data, failure to do so could mean that some large employers will not offer their plans to employees, Almost all of the 30 largest US HMOs now collect and report at least some of this data.