Promote customer perceptions of value: the ladder of effects.

Seven categories of measures are typically used by managed care organizations (MCOs) in monitoring and evaluating the effects of demand improvement efforts on their own performance: (1) member participation in specific initiatives, (2) changes in member mind-states, (3) member behavior, (4) member health status, (5) member service use, and (6) health care expenditures, as well as (7) a variety of value-adding side effects. These same seven can be even more useful to MCOs in monitoring and demonstrating the value they are delivering to their customers. The potential for the MCOs to extend the use of these parameters and gain added value for themselves thereby are discussed, and specific examples are offered to illustrate this potential.