State health plan's oversight criticized

Thursday, January 5, 2006

State health plan's oversight criticized
Audit says focus is on process rather than outcome

By ANGELA GALLOWAY
SEATTLE POST-INTELLIGENCER REPORTER

A state program that provides health coverage to about 102,000 low-wage workers lacks oversight and direction, according an independent audit.

The Basic Health Plan is too focused on process rather than health outcome, and it fails to adequately monitor the companies it pays, according to the report approved Wednesday by the Joint Legislative Audit and Review Committee. The bipartisan group of lawmakers oversees independent evaluations and reviews of state programs at the Legislature's request.

Basic Health provides discount insurance for Washingtonians who earn up to twice the federal poverty level, or about $38,700 a year for a family of four. During the current two-year budget cycle, the program is expected to cost the state $500 million in health services, plus $16 million in administration.

According to the auditors, Basic Health suffers from:

Unclear expectations and insufficient guidelines for the insurers with which it contracts, specifically as it relates to health care quality. For example, the state requires insurers to have two disease-management programs but doesn't track their effectiveness. The agency should spell out its expectations for care outcomes in contracts, they said.

Insufficient monitoring of insurers and the quality of their services. Although Basic Health participates in an interagency state review team, the data that team uses are too broad, auditors said. Also, Basic Health fails to properly scrutinize data on services provided to ensure they're effective and efficient.

Lack of clearly stated strategic goals and objectives, plus insufficient clarity of the roles of top leaders overseeing the program. The program needs explicit objectives to assure quality and efficiency and to set priorities for chronic disease management.

The agency that administers the health plan, the Health Care Authority, partially concurred with the findings. The state is taking steps to better monitor quality, bolstered by standards established by the National Committee for Quality Assurance, the Health Care Authority said.

"We believe that it has been effective and it has been useful, and we've tried to streamline it," said Barney Speight, deputy administrator of the Health Care Authority. "We also acknowledge that there is more that we can do, I would say should do, given the appropriate resources."

P-I reporter Angela Galloway can be reached at 206-448-8333 or angelagalloway@seattlepi.com.

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