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HEALTH CARE POLICY First National Healthplan 'Report Cards' Being Built From the Ground Up If a man says he has trouble getting the health care he needs, this might reflect poorly on his health-care plan. It might, that is, until it is known that the reason for his trouble is the distance he lives from the nearest bus stop.     This kind of background information--important for the individual but irrelevant to the health plan and to other health-care consumers--is data researchers want to screen out when evaluating health plans. A unique aspect of an ongoing federally funded study called CAHPS, the Consumer Assessments of Health Plans Study, is the emphasis it places on gathering and presenting solid data. The study focuses on the very foundation of assessment: constructing survey questions that accurately probe for a specific range of information and developing "report cards" that effectively present the resulting evaluation.     When completed, the health-plan reports not only will describe and rate health plans but guide consumers through the process of choosing which plan is best for them. The study seeks to create the first national standard for assessing health plans, based on data gathered from consumers across the country. The initial consumer survey is due to be released at the end of March for review by the government. The survey's projected time of release for public review is May.     Paul Cleary, professor of medical sociology in the HMS Departments of Health Care Policy and Social Medicine, is one of the leaders in the study, being carried out by three consortia headed by the Medical School, RAND, and Research Triangle Institute. "There is a lot of evaluation," Cleary says of the emphasis on developing questions and report formats, "more than anyone has ever done."     A technique being used is "cognitive testing," which involves interviewing survey respondents to find out their understanding of the survey questions and the rationale for their answers. These efforts have uncovered discrepancies like the one above in which access to care was interpreted by some to include personal issues like proximity to a bus stop or availability of a baby-sitter. This particular question had to be rephrased to ask people about their ability to get needed tests and treatment instead of needed health care, narrowing the scope of responses.     The rise of competition within the U.S. health-care system has made medical care a major issue for the nation. Several organizations have developed report cards, but most of these are based on surveys designed to obtain information for health-plan administrators; the data helps identify areas for quality improvement or marketing. Cleary says not only is this information not geared primarily toward consumers, but "there is a lack of standardization. It is hard to compare among plans."     The CAHPS initiative, sponsored by the federal Agency for Health Care Policy and Research, extends current survey practices by asking consumers about their experiences with their health care and health-care plans. CAHPS also explores related topics such as access to health care, use of plan services or lack of use, quality of care received, and outcomes of treatment. The study has gathered data from a variety of consumer segments.     Underlying these activities are the fundamental components of CAHPS: developing better questionnaires for consumers to evaluate their health-care plans; creating a variety of report formats that encourage consumers to use the information given; producing manuals enabling organizations to gather data themselves; and evaluating the efficacy of these systems.     The study is a five-year project that was begun in October 1995. During phase 1, which lasted about a year, researchers worked collaboratively to develop and test a consumer survey kit, user manual, and reports for use by consumers. Phase 2, now in its early stages, involves demonstration and evaluation and is due to be completed in September of the year 2000. --Robert Neal Back to Top