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Center for Healthcare Policy and Research

Center for Healthcare Policy and Research

Information about quality in a randomized evaluation (INQUIRE)

Principal Investigator
PI Home Department
Source of Support
Dates
Total Cost
Patrick Romano, M.D.
General Medicine and Pediatrics
AHRQ*
9/30/2000 - 8/31/2004
$494,235

Employees’ Retirement System (CalPERS), America's second largest purchaser of health care. Phase I, an observational study linked to CalPERS’ fall 2001 open enrollment (OE), was designed to assess the impact of CalPERS’ standard quality information (report card). Phase II was designed as a randomized controlled trial of more intensive quality dissemination interventions during OE 2002.

We successfully completed Phase I during the period from July 1, 2001 through June 30, 2002, conducting pre- and post-OE surveys of randomly sampled CalPERS members and collecting qualitative data through focus groups. Unfortunately, in the face of unprecedented turmoil and 15-30% premium increases in the California health plan market, CalPERS fundamentally changed its health care purchasing strategy. In essence, they abandoned the "consumer choice" model, in which the smart purchaser creates a level playing field on which different health plans can compete on both cost and quality, in favor of a "partner" model, in which the purchaser partners with one or two plans to more aggressively manage both care and costs. This change in strategy had major implications for Phase II (Year 3) of our project in that CalPERS members would have so few health plans to choose from during OE 2002 that our proposed interventions could not be adequately evaluated.

In 2002, we developed a new partnership with the Pacific Business Group on Health, which manages the PacAdvantage plan. PacAdvantage, also known as the Health Insurance Plan of California (HIPC), is a nonprofit purchasing pool established in 1992 to offer affordable health benefits to small employers in California. It currently provides health coverage for about 147,000 members working for about 11,000 small employers statewide. PacAdvantage offers its a wide array of health plan choices and is a good setting for testing the impact of educating and motivating consumers about health plan choice. Beginning in May 2003, when the majority of PacAdvantage members participate in OE, we implemented Phase II, the randomized trial of the intensive quality dissemination. A sample of PacAdvantage members were randomly allocated to one of four intervention subgroups – the “Information Content: Personalized Reports” intervention, the “Education/Motivation: Active Consumer Education” intervention, both, or neither. Only the “Education/Motivation” intervention has been implemented to date. Members assigned to this group received an invitation to call a toll-free number to speak with a Health Plan Quality Advisor at the “Quality Information Education Center”. The advisors are specially trained to “activate” consumers by (1) educating them about quality information and its use, (2) motivating them to use this information to get better health care for themselves and their families, and (3) answering any general questions they may have related to quality of care and health plan/medical group choice. The Quality Information Education Center will continue to operate until the end of July 2003. During the summer and fall 2003, all sampled PacAdvantage members will be sent a Post-Intervention questionnaire to measure the impact of the intervention. Measures of impact include health plan or medical group switching (or contemplation thereof), knowledge of the health care market, satisfaction with current plan and medical group, trust or confidence in the plan and physician, and self-efficacy related to health plan and provider interactions. Our results will help to establish a benchmark for future dissemination efforts by both private and public purchasers.