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UnitedHealth Group, the third-largest HMO in the country, says it has been able to improve the quality of care its member physicians provide by using billing data to track patient care. According to The Wall Street Journal (August 19, 1999:B4), UnitedHealth supports its claim with a recent evaluation of performance of more than 42,000 doctors in 17 states, all participants in one of the HMO's plans. The evaluation shows that those physicians are doing a better job of providing medical care than when the HMO first assessed the situation in 1997.

In this 1997 assessment, UnitedHealth reviewed data for its plans in 4 cities and found inconsistencies in the level of care given to patients. The HMO sent confidential reports of such patients to physicians, who determined if a mistake was made, if the patient did not follow their recommendations, or if the standard treatment was not prescribed for some reason.

For example, if UnitedHealth claims data indicate that a heart attack patient has not been billed for a prescription to beta-blockers--a standard deterrent to recurring heart attacks--the HMO can let the physician know.

The latest UnitedHealth evaluation has indicated marked improvements in a wide range of commonly accepted clinical measures: Among 63,846 diabetic patients in 23 medical plans, doctors gave 76% of the patients a glycated hemoglobin blood test within the past year, up from 71% in 1998. In one case, the HMO informed a physician that 20 female patients had not had mammogram tests for possible breast cancer. The physician followed up, and most of the patients have since gone in for testing.

# posted by Medical Information : 3:12 AM