Health Plan Quality: Factors Influencing Hospital Participation in Health Plans

The professional and popular literatures are full of reports of surveys and studies purporting to rate health plans. Health maintenance organizations and other organizations are surveying member satisfaction. Accreditation of health plans is receiving increased attention. Interest is growing in plans\u27 performance in the areas measured by the Health Plan Employers\u27 Data and Information Set (HEDIS). The factors measured in current ratings and accreditation systems are not important to hospitals for evaluating health plan participation. There are factors in a health plan\u27s performance that are important to and either beneficial or detrimental to hospitals. This paper proposes factors upon which health care plans should be evaluated and rated to measure their business partner quality from the hospital perspective