Accountability to Consumers

• 1). Evaluate health plan quality by comparing the cost of services to the perceived service value, the Center for Studying Health System Change (HSC) suggests. Consumers are interested in high-quality, low-cost access to the most qualified health-care resources. The HSC says health plans can respond to consumer demands and improve their competitive advantage by providing access to more high-performing physicians and hospitals, defined as improved quality and efficiency.
  
  
• 2). Offer consumer-driven health care plans (CDHPs). Advocates of such plans say employers should offer the option of Health Savings Accounts, Health Reimbursement Arrangements and similar plans to drive consumers to take more financial responsibility and become better informed about health care options. Insure.com says in a June, 2010 article that "the idea behind CDHPs is that people will act more like consumers when it comes to their health care if more of their own money is on the line." However a survey by the Employee Benefits Research Institute "found that those covered by CDHPs were 'significantly more likely' to defer or avoid medical care -- particularly in cases where the insured had a household income below $50,000 or a chronic health condition," the article said.
  
  
• 3). Provide quality transparency to consumers. HSC studies conclude that consumers want more unbiased and easily accessible information about health-plan quality. Health plans that use third-party vendors such as Subimo, Hospital Advisor, Health Forum and HealthGrades can provide easily accessible, high quality data to support better consumer decision-making. According to HSC, many health plans strive to gain a quality competitive edge and become a more valuable intermediary by providing easily accessible consumer information on health-plan quality.
  
  

Oversight Organizations

• 1). Encourage providers, consumers and patients to use evidence-based information for health care decision-making. To advance quality competition among health plans, the Agency for Healthcare Research and Quality (AHRQ) focuses on evidence that proves which interventions are most effective, based on actual patient results. They deploy quality measures and collaborate with Centers for Medicare and Medicaid Services (CMS), and the U.S. Health and Human Services division, to publish quality measures among health plans and spur healthy competition.
  
  
• 2). Focus on quality of health care services by comparing quality and value. NCQA Health Plan Accreditation uses a set of standards to evaluate health plan offerings, and measure core systems, processes and actual results achieved. Their Healthcare Effectiveness Data and Information Set (HEDIS) tool measures multiple dimensions of health care, and is used by 90 percent of America's health plans. Their goal is to improve health-plan quality and drive health plan competition.
  
  
• 3). Hold all health plans accountable for health care quality. The Centers for Medicare and Medicaid Services (CMS) provides oversight for health plan delivery of medical services. According to the New England Journal of Medicine, "the government must hold all plans accountable for the care they provide and minimize plans' ability to prosper through a favorable risk selection." The government can ensure that health plans do not select only the healthiest individuals as clients, simply to improve their financial position. NEJM says health plans must compete on quality by providing information on intervention effectiveness, by collaborating with providers, and by demonstrating patient respect across a broad spectrum of patients.