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

136
While we are in the midst of this evolution of measures that can be used to assess the quality of care,
we also need to consider whether we should allow the current state of our knowledge about quality
measures to lead to actions that could preclude future improvement. In particular, one issue is
whether plans should collect and provide purchasers encounter data describing all the services
delivered. While there is increasing provision of HEDIS or FACCT measures to purchasers, there
is some resistance to furnishing comprehensive encounter data.
In part, the opposition to the provision of encounter data may be associated with the fact that, at this
point, there are limited uses for such data because of the lack of appropriate conceptual measures
for either the receipt of particular services or outcomes associated with services. While I believe that
our set of valid and useful measures is going to improve over time, we need to be concerned about
our ability to produce that information in the future. We need to be aware of the fact that if today
we are developing information systems that are focused on the existing sets of HEDIS or FACCT
measures, we are going to incur expensive retooling in the future in order to be able to provide the
new measures for future HEDIS or future FACCT systems, or for some of their successors. By
developing the capacity to collect encounter data today, there will be an opportunity to quickly
implement different measures as they are developed.
It is also an often overlooked fact that encounter data will be essential for the rate setting process in
the future. At this point, rate setting is an easy task -- let us say a relatively easy task, given all that
has been said about the difficulties of risk adjustment-- because fee-for-service information about
the receipt of services does exist and can be used as a benchmark for establishing rates. In the
future, more and more individuals enrolling in managed care will result in much less fee-for-service
data. The lack of encounter data then will be a significant barrier to establishing appropriate rates
for the payment of services. One can only imagine how quickly this is going to happen, given the
movement to managed care, as well as significant changes that the provision of medical services
undergo as medical knowledge develops over time.
Comments of Dr. Scanlon Summarizing Discussion in Forum Three: Quality and Outcome
Measures, July 15, 1997 5