Employers press HMOs for documentation Vast patient data bases should pinpoint successes

September 24, 1995|By NEW YORK TIMES NEWS SERVICE

A group that includes some of the nation's largest employers is pushing health maintenance organizations to feed massive data bases of patient records into powerful computers to determine for the first time the most effective treatments for bbTC broad range of major illnesses.

The employers contend that without such information it is impossible for them or consumers to determine whether the health groups are providing high-quality care and whether some are providing better care than others.

Careful follow-up studies of the long-term results of medical treatments have been proposed for more than a century; Florence Nightingale proposed such research in 1856.

But clinical doctors and medical scientists have resisted them on the grounds that gathering enough data to produce valid scientific conclusions would be too difficult and costly.

Now such studies are deemed possible because of computers and the growth of HMOs, some of which have millions of patients and thus access to vast stores of easily retrievable medical records.

The employers selected nine major medical conditions for long-term study and plan to add more ailments to the list as the project progresses.

They cited preliminary and smaller-scale studies of asthma and diabetes as examples of how the right treatments, properly followed and assessed, can make a crucial difference in improved health while lowering long-term costs.

One study, recently reported in the Journal of the American Medical Association, disclosed that the most successful procedures for monitoring a diabetic patient's blood sugar were being employed only 16 percent of the time.

In the past, most medical studies have been undertaken to determine the efficacy of a new or refined treatments at experimental stages. But once the treatments have been approved and become part of accepted practice, there are typically few attempts later to compare the results with those of alternative treatments.

Last summer, 30 representatives of major purchasers of health insurance, including American Telephone and Telegraph, Pepsico and GTE Laboratories, along with federal and state insurance-purchasing agencies, joined forces to create the Foundation for Accountability, to push HMOs toward improved quality.

In a report issued yesterday, the foundation asserted that while the health groups had proved their ability to reduce the overall costs of health care, they were not gathering and providing enough information about the quality and effectiveness of that care to enable employers and consumers to make appropriate decisions on which health plans to choose.

"Those who pay the largest shares -- government insurance pools and private employers -- are unable to account for their dollars," the report said. "They cannot determine which services were procured and whether or not they produced value corresponding to the level of expense.

"Those who receive these services -- the American people -- have no mechanism for assessing the quality of care they received, except through anecdotes -- usually negative."

Dr. Rodney Armstead, who until last month was the director of the office of managed care in the federal government's Health Care Financing Administration, and the co-chairman of the committee that set up the new foundation, said the cost of the project "will be junk change compared to the value of the benefits."

"If a company has 100,000 employees," he said, "and spends . . . say, 60 cents per employee to monitor the health care provided its employees, it might save 1 percent of its $25 million annual health care costs -- or $2.5 million a year."

He said about $1 million would be needed by March to begin the working phase of the project. Half that sum has been pledged by the foundation members.

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