Medicaid Managed Care - U.S. Senate Special Committee on Aging

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unlikely though that these future HEDIS measures will include many, or perhaps any, that relate
specifically to the very low incidence complex conditions we have been discussing.
FACCT, or the Foundation for Accountability, represents a second prominent effort to identify
information to measure plan performance. FACCT, which was established in 1995, is an
organization of purchasers and consumers which represents the demand side of the healthcare
market, as opposed to the NCQA, HEDIS's sponsor, which is more representative of the supply side.
While FACCT attempts to focus on health care provided to consumers in the general population, as
well as care provided to those with specific conditions, they focus on conditions that are more
prevalent and that are thought to be of interest to a broader segment of the population. They also
emphasize conditions where it is believed plans can make a difference in terms of improving health.
FACCTs approach involves selection of different clinical conditions--such as asthma, breast cancer.
diabetes, or major depression--and then identification of a set of associated process and outcome
measures. In these sets of measures, there are measures that reflect access to particular services.
There is interest in including services that represent the state-of-the-art of care and services that
represent good preventive care. There are also outcomes -- measures -- either intermediate outcomes
such as the early detection of a disease, as well as survival rates for particular disease. Finally, there
are measures of consumer satisfaction with the services that are being provided.
It is very easy to identify the shortcomings in the approaches that I have just outlined, relative to
fully capturing the quality of services being provided to the general population of individuals that
are enrolled in a managed care organization, and even more so for the care of the population of
individuals with special needs. However, I think, in order to be fair, we need to recognize that these
efforts are in their infancy. We only relatively recently have developed a considerable interest in
assessing the services and the quality of services that managed care organizations are providing.
There has been considerable evolution in the approaches, and progress continues to be made.
Having said that, it is also important to think about the measures that we have available in the
Comments of Dr. Scanlon Summarizing Discussion in Forum Three: Quality and Outcome
Measures, July 15, 1997
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