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Ron D Hays - One of the best experts on this subject based on the ideXlab platform.
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psychometric performance of the consumer assessment of Healthcare providers and systems cahps 4 0 adult Health Plan survey
Primary Health Care, 2012Co-Authors: Kelly Chong, Peter C Damiano, Ron D HaysAbstract:Background: The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Health Plan survey is widely used to assess quality of care from the patient perspective. The objective of this study was to assess the psychometric performance of a preliminary version of the CAHPS 4.0 Health Plan Survey. Methods: Data were obtained from a sample of 597 adults enrolled in one of two Medicaid managed care Health Plans in Iowa. Item-scale correlations and confirmatory factor analysis were estimated to examine item convergence and discrimination. Reliability of each multi-item scale (doctor communication, getting care quickly, delays in start of appointments, getting needed care, office staff courtesy and respect) was assessed at the individual enrollee and Health Plan levels. Plan-level reliability of individual items and global ratings was also estimated. Multivariate regressions were used to model the associations of the multi-item scales with global ratings of care and “recommend to others” bottom-line items. Results: The multi-item scales were generally acceptable for group comparisons, with a median internal consistency reliability coefficient of 0.78. The doctor communication composite (6 items, alpha = 0.92) had the highest and delays in start of appointment (2 items, alpha = 0.57) the lowest internal consistency reliability. Item discrimination across scales was generally supported. Plan level reliability was above 0.70 for the “global rating of personal doctor” and “recommend Health Plan to others” item. “Getting needed care” and “office staff courtesy and respect” items had Plan-level reliabilities of 0.70 and 0.82, respectively. Confirmatory factor analysis provided support for a 5-factor model (Satorra-Bentler χ2 = 597.01, df = 109, P < 0.001; CFI = 0.871, RMSEA = 0.089, AIC = 379.01). The five reporting composites were positively associated with all global ratings and “recommend to others” items. The largest correlations were observed between doctor communication and the global rating of personal doctor (r = 0.75) and “recommend personal doctor to others” (r = 0.73). Conclusion: This study provides support for psychometric properties of CAHPS 4.0 Health Plan Survey measures.
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developing a spanish language consumer report for cahps Health Plan surveys
The Joint Commission Journal on Quality and Patient Safety, 2007Co-Authors: Kathryn Pitkin Derose, David E. Kanouse, Beverly A Weidmer, Robert Weechmaldonado, Rosa Elena Garcia, Ron D HaysAbstract:Article-at-a-Glance Background A Spanish-language consumer report on Health Plan quality was developed for the Consumer Assessments of Healthcare Providers and Systems (CAHPS ® ) project. Methods Multiple translations, a committee review, and a readability assessment were performed to produce a draft Spanish report. The report was revised on the basis of a series of cognitive interviews with 24 Latinos. Results The median age of participants was 41 years, and the median number of years in the United States was 9; 67% were female, and 63% had less than a high school education. In general, participants understood the report and said they would use it to choose a Health Plan. Less-educated respondents had difficulty understanding the segmented bar graphs that showed the proportion of Health Plan members' responses. A summary chart comparing all Health Plans on all dimensions was easier to comprehend when differences were represented by word icons rather than by stars. Discussion Concepts and terms about Health care quality translated well from English to Spanish. Simplifying graphical information involves losing some detail but makes information more usable. Summary charts facilitate comparisons across Plans, but differences relative to a mean are difficult for both Spanish- and English-speaking consumers to understand.
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effect of cahps performance information on Health Plan choices by iowa medicaid beneficiaries
Medical Care Research and Review, 2002Co-Authors: Donna O. Farley, David E. Kanouse, Marc N. Elliott, Pamela Farley Short, Peter C Damiano, Ron D HaysAbstract:This evaluation tested if Consumer Assessment of Health Plans Study (CAHPS) information on Plan performance affected Health Plan choices by new beneficiaries in Iowa Medicaid. New cases entering Medicaid in selected counties during February through May 2000 were assigned randomly to experimental or control groups. The control group received standard Medicaid enrollment materials, and the experimental group received these materials plus a CAHPS report. We found that CAHPS information did not affect Health Plan choices by Iowa Medicaid beneficiaries, similar to previously reported findings for New Jersey Medicaid. However, it did affect Plan choice in an earlier laboratory experiment. The value of this information may be limited to a subset of receptive consumers who actively study information received, even then only when (1) ratings of available Plans differ greatly, (2) ratings differ from prior beliefs about Plan quality, and (3) reports are easy to understand.
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effects of cahps Health Plan performance information on Plan choices by new jersey medicaid beneficiaries
Health Services Research, 2002Co-Authors: Donna O. Farley, David E. Kanouse, Marc N. Elliott, Pamela Farley Short, Julie A Brown, Ron D HaysAbstract:Objective To assess the effects of CAHPS Health Plan performance information on Plan choices and decision processes by New Jersey Medicaid beneficiaries.
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Do consumer reports of Health Plan quality affect Health Plan selection
Health services research, 2000Co-Authors: Mark Spranca, David E. Kanouse, Marc N. Elliott, Pamela Farley Short, Donna O. Farley, Ron D HaysAbstract:OBJECTIVE: To learn whether consumer reports of Health Plan quality can affect Health Plan selection. DATA SOURCES: A sample of 311 privately insured adults from Los Angeles County. STUDY DESIGN: The design was a fractional factorial experiment. Consumers reviewed materials on four hypothetical Health Plans and selected one. The Health Plans varied as to cost, coverage, type of Plan, ability to keep one's doctor, and quality, as measured by the Consumer Assessment of Health Plans Study (CAHPS) survey. DATA ANALYSIS: We used multinomial logistic regression to model each consumer's choice among Health Plans. PRINCIPAL FINDINGS: In the absence of CAHPS information, 86 percent of consumers preferred Plans that covered more services, even though they cost more. When CAHPS information was provided, consumers shifted to less expensive Plans covering fewer services if CAHPS ratings identified those Plans as higher quality (59 percent of consumers preferred Plans covering more services). Consumer choices were unaffected when CAHPS ratings identified the more expensive Plans covering more services as higher quality (89 percent of consumers preferred Plans covering more services). CONCLUSIONS: This study establishes that, under certain realistic conditions, CAHPS ratings could affect consumer selection of Health Plans and ultimately contain costs. Other studies are needed to learn how to enhance exposure and use of CAHPS information in the real world as well as to identify other conditions in which CAHPS ratings could make a difference.
Frank J Wharam - One of the best experts on this subject based on the ideXlab platform.
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association between switching to a high deductible Health Plan and major cardiovascular outcomes
JAMA Network Open, 2020Co-Authors: Frank J Wharam, Dennis Rossdegnan, Fang Zhang, Jamie Wallace, Adrian F Hernandez, Joseph P NewhouseAbstract:Importance Most people with commercial Health insurance in the US have high-deductible Plans, but the association of such Plans with major Health outcomes is unknown. Objective To describe the association between enrollment in high-deductible Health Plans and the risk of major adverse cardiovascular outcomes. Design, Setting, and Participants This cohort study examined matched groups before and after an insurance design change. Data were from a large national commercial (and Medicare Advantage) Health insurance claims data set that included members enrolled between January 1, 2003, and December 31, 2014. The study group included 156 962 individuals with risk factors for cardiovascular disease who were continuously enrolled in low-deductible (≤$500) Health Plans during a baseline year followed by up to 4 years in high-deductible (≥$1000) Plans with typical value-based features after an employer-mandated switch. The matched control group included 1 467 758 individuals with the same risk factors who were contemporaneously enrolled in low-deductible Plans. Data were analyzed from December 2017 to March 2020. Exposures Employer-mandated transition to a high-deductible Health Plan. Main Outcomes and Measures Time to first major adverse cardiovascular event defined as myocardial infarction or stroke. Results The study group included 156 962 individuals and the control group included 1 467 758 individuals; the mean age of members was 53 years (SD: high-deductible group, 6.7 years; control group, 6.9 years), 47% were female, and approximately 48% lived in low-income neighborhoods. First major adverse cardiovascular events among high-deductible Health Plan members did not differ relative to controls at follow-up vs baseline (adjusted hazard ratio, 1.00; 95% CI, 0.89-1.13). Findings were similar among subgroups with diabetes (adjusted hazard ratio, 0.93; 95% CI, 0.75-1.16) and with other cardiovascular risk factors (adjusted hazard ratio, 0.93; 95% CI, 0.81-1.07). Conclusions and Relevance Mandated enrollment in high-deductible Health Plans with typical value-based features was not associated with increased risk of major adverse cardiovascular events.
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provider level rates of hedis consistent hpv vaccination in a regional Health Plan
Human Vaccines & Immunotherapeutics, 2019Co-Authors: Catherine A Panozzo, Melissa B Gilkey, Melanie L Kornides, Frank J WharamAbstract:Background. Health insurers are well-positioned to address low HPV vaccination coverage in the US through initiatives such as provider assessment and feedback. However, little is known about the feasibility of using administrative claims data to assess provider performance on vaccine delivery. Methods. We used administrative claims data from a regional Health Plan to estimate provider performance on the 2013-2015 Healthcare Effectiveness Data and Information Set (HEDIS) measure for HPV vaccine. This measure required that a girl receive three doses of HPV vaccine by age 13. Providers who administered ≥1 dose in a HEDIS-consistent series received credit for meeting the goal. Results. From January 2008-April 2015, 1,975 (8.5%) of 11-12 year-old girls in our sample received a HEDIS-consistent HPV vaccine series. Our sample of providers consisted of 1,236 who had ≥10 well-visits with different female patients, and 94% of these were pediatricians. A substantial minority of providers (39.4%) did not administer any HEDIS-consistent HPV vaccine doses. Only 5.5% of providers administered HPV vaccine doses that were part of a HEDIS-consistent series to at least one-quarter of their patients. These estimates did not vary by provider sex or age. Doses in a HEDIS-consistent vaccine series were often attributed to multiple providers. Conclusions. In a regional Health Plan, only 5.5% of providers in our sample administered doses that were part of a complete, three-dose HPV vaccine series to at least one-quarter of their 11-12 year-old female patients.
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the association between high deductible Health Plan transition and contraception and birth rates
Health Services Research, 2016Co-Authors: Amy J Graves, Ken Kleinman, Katy B Kozhimannil, Frank J WharamAbstract:OBJECTIVE: To evaluate the association between employer-mandated enrollment into high-deductible Health Plans (HDHPs) and contraception and birth rates among reproductive-age women. DATA SOURCES/STUDY SETTING: Using data from 2002 to 2008 we examined 1559 women continuously enrolled in a Massachusetts Health Plan for 1 year before and after an employer-mandated switch from an HMO to a HDHP compared with 2793 matched women contemporaneously enrolled in an HMO. STUDY DESIGN: We used an individual-level interrupted time series with comparison series design to examine level and trend changes in clinician-provided contraceptives and a differences-in-differences design to assess annual birth rates. DATA COLLECTION/EXTRACTION METHODS: Employer Plan and member characteristics were obtained from enrollment files. Contraception and childbirth information were extracted from pharmacy and medical claims. PRINCIPAL FINDINGS: Monthly contraception rates were 19.0-24.0 percent at baseline. Level and trend changes did not differ between groups (p = .92 and p = .36 respectively). Annual birth rates declined from 57.1/1000 to 32.7/1000 among HDHP members and from 61.9/1000 to 56.2/1000 among HMO controls a 40 percent relative reduction in odds of childbirth (odds ratio = 0.60; p = .02). CONCLUSIONS: Women who switched to HDHPs experienced a lower birth rate which might reflect strategies to avoid childbirth-related out-of-pocket costs under HDHPs. (c) Health Research and Educational Trust.
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cancer screening before and after switching to a high deductible Health Plan
Annals of Internal Medicine, 2008Co-Authors: Frank J Wharam, Alison A Galbraith, Dennis Rossdegnan, Stephen B Soumerai, Ken Kleinman, Bruce E LandonAbstract:Results: Cancer screening in the high-deductible Health Plan group was unchanged from baseline to follow-up (adjusted ratios of change, 1.04 [95% CI, 0.91 to 1.19] for breast cancer, 1.04 [CI, 0.92 to 1.17] for cervical cancer, and 1.02 [CI, 0.89 to 1.16] for colorectal cancer). High-deductible Health Plan members had colonoscopy, flexible sigmoidoscopy, and DCBE less often (ratio of change, 0.73 [CI, 0.56 to 0.95]) and FOBT more often (ratio of change, 1.16 [CI, 1.01 to 1.33]) than HMO members. Limitations: Population screening frequency was probably underestimated because the study could not assess screening before the baseline year. The study may have included people ineligible for screening because of previous colectomy, mastectomy, or hysterectomy. The findings are limited to a population with relatively high socioeconomic status, which is typical of employed, commercially insured populations. Conclusion: Members of a high-deductible Health Plan did not seem to change their use of breast, cervical, and colorectal cancer screening when tests were fully covered. However, members may have substituted a fully covered screening test (FOBT) for tests subject to the deductible (colonoscopy, flexible sigmoidoscopy, and DCBE).
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emergency department use and subsequent hospitalizations among members of a high deductible Health Plan
JAMA, 2007Co-Authors: Frank J Wharam, Alison A Galbraith, Stephen B Soumerai, Bruce E Landon, Ken Kleinman, Dennis RossdegnanAbstract:ContextPatients evaluated at emergency departments often present with nonemergency conditions that can be treated in other clinical settings. High-deductible Health Plans have been promoted as a means of reducing overutilization but could also be related to worse outcomes if patients defer necessary care.ObjectivesTo determine the relationship between transition to a high-deductible Health Plan and emergency department use for low- and high-severity conditions and to examine changes in subsequent hospitalizations.Design, Setting, and ParticipantsAnalysis of emergency department visits and subsequent hospitalizations among 8724 individuals for 1 year before and after their employers mandated a switch from a traditional Health maintenance organization Plan to a high-deductible Health Plan, compared with 59 557 contemporaneous controls who remained in the traditional Plan. All persons were aged 1 to 64 years and insured by a Massachusetts Health Plan between March 1, 2001, and June 30, 2005.Main Outcome MeasuresRates of first and repeat emergency department visits classified as low, indeterminate, or high severity during the baseline and follow-up periods, as well as rates of inpatient admission after emergency department visits.ResultsBetween the baseline and follow-up periods, emergency department visits among members who switched to high-deductible coverage decreased from 197.5 to 178.1 per 1000 members, while visits among controls remained at approximately 220 per 1000 (−10.0% adjusted difference in difference; 95% confidence interval [CI], −16.6% to −2.8%; P = .007). The high-deductible Plan was not associated with a change in the rate of first visits occurring during the study period (−4.1% adjusted difference in difference; 95% CI, −11.8% to 4.3%). Repeat visits in the high-deductible group decreased from 334.6 to 255.3 visits per 1000 members and increased from 321.1 to 334.4 per 1000 members in controls (−24.9% difference in difference; 95% CI, −37.5% to −9.7%; P = .002). Low-severity repeat emergency department visits decreased in the high-deductible group from 142.5 to 92.1 per 1000 members and increased in controls from 128.0 to 132.5 visits per 1000 members (−36.4% adjusted difference in difference; 95% CI, −51.1% to −17.2%; P<.001), whereas a small decrease in high-severity visits in the high-deductible group could not be excluded. The percentage of patients admitted from the emergency department in the high-deductible group decreased from 11.8 % to 10.9% and increased from 11.9% to 13.6% among controls (−24.7% adjusted difference in difference; 95% CI, −41.0% to −3.9%; P = .02).ConclusionsTraditional Health Plan members who switched to high-deductible coverage visited the emergency department less frequently than controls, with reductions occurring primarily in repeat visits for conditions that were not classified as high severity, and had decreases in the rate of hospitalizations from the emergency department. Further research is needed to determine long-term Health care utilization patterns under high-deductible coverage and to assess risks and benefits related to clinical outcomes.
Jon B. Christianson - One of the best experts on this subject based on the ideXlab platform.
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the effect of quality information on consumer Health Plan switching evidence from the buyers Health care action group
Journal of Health Economics, 2006Co-Authors: Jean M Abraham, Roger Feldman, Caroline S Carlin, Jon B. ChristiansonAbstract:Abstract We examine the factors that lead employees to search for Health Plan quality information and the effect of such information on the decision to switch Plans. Extending Hirshleifer and Riley's model [Hirshleifer, J., Riley, J.G., 1979. The analytics of uncertainty and information—an expositional survey. Journal of Economic Literature 17 (December (4)), 1375–1421] of the economics of information, we develop a two-equation model of quality information awareness and switching behavior. We estimate the model using data from a random sample of 651 single employees from 16 firms that are members of the Buyers Health Care Action Group, a Health care purchasing coalition in the Minneapolis–St. Paul region. Our empirical results do not support either a link between quality information and switching behavior, or between perceived Health Plan satisfaction and switching. We do, however, find that switching is influenced by changes in premiums and whether an individual has an existing relationship with a Health care provider.
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evaluation of the effect of a consumer driven Health Plan on medical care expenditures and utilization
Health Services Research, 2004Co-Authors: Stephen T. Parente, Roger Feldman, Jon B. ChristiansonAbstract:Objective. To compare medical care costs and utilization in a consumer-driven Health Plan (CDHP) to other Health insurance Plans. Study Design. We examine claims and employee demographic data from one large employer that adopted a CDHP in 2001. A quasi-experimental pre–post design is used to assign employees to three cohorts: (1) enrolled in a Health maintenance organization (HMO) from 2000 to 2002, (2) enrolled in a preferred provider organization (PPO) from 2000 to 2002, or (3) enrolled in a CDHP in 2001 and 2002, after previously enrolling in either an HMO or PPO in 2000. Using this approach we estimate a difference-in-difference regression model for expenditure and utilization measures to identify the impact of CDHP. Principal Findings. By 2002, the CDHP cohort experienced lower total expenditures than the PPO cohort but higher expenditures than the HMO cohort. Physician visits and pharmaceutical use and costs were lower in the CDHP cohort compared to the other groups. Hospital costs and admission rates for CDHP enrollees, as well as total physician expenditures, were significantly higher than for enrollees in the HMO and PPO Plans. Conclusions. An early evaluation of CDHP expenditures and utilization reveals that the new Health Plan is a viable alternative to existing Health Plan designs. Enrollees in the CDHP have lower total expenditures than PPO enrollees, but higher utilization of resource-intensive hospital admissions after an initially favorable selection.
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changes in the process of care for medicaid patients with schizophrenia in utah s prepaid mental Health Plan
Psychiatric Services, 1998Co-Authors: Michael K Popkin, Nicole Lurie, Willard G Manning, Jeffrey S Harman, Allan Callies, Donald Z Gray, Jon B. ChristiansonAbstract:OBJECTIVE: Changes in the process of psychiatric care received by Medicaid beneficiaries with schizophrenia were examined after the introduction of capitated payments for enrollees of some community mental Health centers (CMHCs) under the Utah Prepaid Mental Health Plan. METHODS: Data from the medical records of 200 patients receiving care in CMHCs participating in the prepaid Plan were compared with data from the records of 200 patients in nonparticipating CMHCs, which remained in a fee-for-service reimbursement arrangement. Using the Process of Care Review Form, trained abstracters gathered data characterizing general patient management, social support, medication management, and medical management before implementation of the Plan in 1990 and for three follow-up years. Using regression techniques, differences in the adjusted changes between third-year follow-up and baseline were examined by treatment site. RESULTS: By year 3 at the CMHCs participating in the Plan, psychotherapy visits decreased, the pr...
Lauramae Baldwin - One of the best experts on this subject based on the ideXlab platform.
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Health Plan adaptations to a mailed outreach program for colorectal cancer screening among medicaid and medicare enrollees the benefit study
Implementation Science, 2020Co-Authors: Gloria D Coronado, Jennifer L Schneider, Beverly B Green, Jennifer Coury, Malaika Schwartz, Yogini Kulkarnisharma, Lauramae BaldwinAbstract:BACKGROUND Promoting uptake of evidence-based innovations in Healthcare systems requires attention to how innovations are adapted to enhance their fit with a given setting. Little is known about real-world variation in how programs are delivered over time and across multiple populations and contexts, and what motivates adaptations. METHODS As part of the BeneFIT study of mailed fecal immunochemical tests (FIT) to increase colorectal cancer screening, we interviewed 9 leaders from two participating Medicaid/Medicare Health insurance Plans to examine adaptations to their Health Plan-initiated mailed FIT outreach programs in the second year of implementation. We applied an adaptation and modification model developed by Stirman and colleagues to document content and context modifications made to the two programs. RESULTS Both Health Plans made substantial changes to their programs in the second year; adaptations differed substantially across Health Plans. In Health Plan Oregon, adaptations generally targeted Health centers and member populations, most content adaptations involved tailoring program components, and the program was expanded to four additional Health centers. In contrast, Health Plan Washington's second-year content adaptations were primarily at the level of members, and generally involved adding program components. Moreover, Health Plan Washington undertook large-scale context adaptations to the setting where the program was led (local vs. national), the personnel who administered the program (vendor and staffing), and the population selected for outreach (limiting outreach to dual-eligible members). CONCLUSIONS Both programs implemented a variety of adaptations that reflected the values and incentives of the broader Health Plan contexts. Financial incentives for screening allowed Health Plan Oregon to expand but led Health Plan Washington to offer more targeted outreach to a subset of eligible enrollees. The breadth of changes made by each Health system reflects the necessity of evaluating programs in context and adjusting to specific challenges as they are identified. Further research is needed to understand the effects of these types of adaptations on program efficiency and enrollee and Health system outcomes.
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first year implementation of mailed fit colorectal cancer screening programs in two medicaid medicare Health insurance Plans qualitative learnings from Health Plan quality improvement staff and leaders
BMC Health Services Research, 2020Co-Authors: Lauramae Baldwin, Jennifer L Schneider, Beverly B Green, Malaika Schwartz, Jennifer S Rivelli, Amanda F Petrik, Gloria D CoronadoAbstract:Colorectal cancer screening rates remain low, especially among certain racial and ethnic groups and the uninsured and Medicaid insured. Clinics and Health care systems have adopted population-based mailed fecal immunochemical testing (FIT) programs to increase screening, and now Health insurance Plans are beginning to implement mailed FIT programs. We report on challenges to and successes of mailed FIT programs during their first year of implementation in two Health Plans serving Medicaid and dual eligible Medicaid/Medicare enrollees. This qualitative descriptive study gathered data through in-depth interviews with staff and leaders at each Health Plan (n = 10). The Consolidated Framework for Implementation Research, field notes from program Planning meetings between the research team and the Health Plans, and internal research team debriefs informed interview guide development. Qualitative research staff used Atlas.ti to code the Health Plan interviews and develop summary themes through an iterative content analysis approach. We identified first-year implementation challenges in five thematic areas: 1) program design, 2) vendor experience, 3) engagement/communication, 4) reaction/satisfaction of stakeholders, and 5) processing/returning of mailed kits. Commonly experienced challenges by both Health Plans related to the time-consuming nature of the programs to set up, and complexities and delays in working with vendors. We found implementation successes in the same five thematic areas as well as four additional areas of: 1) leadership support, 2) compatibility with the Health Plan, 3) broader impacts, and 4) collaboration with researchers. Commonly experienced successes included the ability to adapt the mailed FIT program to the individual Health Plan culture and needs, and the synchronicity between the programs and their organizational missions and goals. Both Health Plans successfully adapted mailed FIT programs to their own culture and resources and used their strong quality management resources to maximize success in overcoming the time demands of setting up the program and working with their vendors. Mailed FIT programs administered by Health Plans, especially those serving Medicaid- and dual eligible Medicaid/Medicare-insured populations, may be an important resource to support closing gaps in colorectal cancer screening among traditionally underserved populations.
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qualitative assessment of washington state medicaid Health Plan readiness to implement systems based approaches to colorectal cancer screening
Inquiry : a journal of medical care organization provision and financing, 2019Co-Authors: Elizabeth Witwer, Lauramae Baldwin, Allison M ColeAbstract:Implementation of population-based colorectal cancer screening programs by Medicaid Health Plans could address colorectal cancer screening disparities. Our objective is to identify facilitators and barriers to implementation of a population-based colorectal cancer screening program by Washington State Medicaid Health Plans. We conducted semi-structured interviews with leadership from 2 statewide and 3 national Medicaid Plans. We organized the interview questions around the Consolidated Framework for Implementation Research (CFIR). We analyzed interview transcripts, guided by directed content analysis, and identified facilitators and barriers to Medicaid Health Plan implementation of population-based colorectal cancer screening programs. Robust Health Plan (inner setting) quality improvement infrastructures were facilitators. Lack of statewide Medicaid policy incentives (external setting) to increase colorectal cancer screening were barriers to potential implementation. Efforts to address identified barriers through local and national policies and statewide data sharing efforts may support Medicaid Health Plan implementation of population-based colorectal cancer screening programs.
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continuity of care and cancer screening among Health Plan enrollees
Medical Care, 2008Co-Authors: Joshua J Fenton, Peter Franks, Robert J Reid, Joann G Elmore, Lauramae BaldwinAbstract:Context: Although having a usual source of care has been associated with cancer screening, whether there is additional benefit from continuity with a specific physician is uncertain. In addition, little is known about the relationship between continuity of care and receipt of colorectal and prostate cancer screening. Methods: Subjects were enrolled in a Washington State Health Plan that operates an integrated delivery system that emphasizes access to primary care. Among patients age 50-78 years old with 2 or more primary care visits in 2002-2003 (N = 67,633), we determined whether higher continuity (≥50% of visits with the most visited primary care provider) was associated with colorectal, breast, and prostate cancer screening. Random-effects logistic regression estimated adjusted percentages of patients who received fecal occult blood testing, lower endoscopy (sigmoidoscopy or colonoscopy), screening mammography, and prostate specific antigen (PSA) testing. Results: Patients with higher continuity were more likely to receive fecal occult blood testing than patients with lower continuity (28.9% vs. 26.8%; P < 0.001) but less likely to receive lower endoscopy (12.9% vs. 14.3%; P < 0.001). Although higher continuity was not significantly associated with screening mammography (P = 0.38), men with higher continuity were more likely to receive PSA testing than men with lower continuity (39.4% vs. 37.4%; P = 0.008). Conclusions: In an insured population with a high degree of primary care access, continuity with a specific primary care physician was associated with the selection of less invasive colorectal cancer screening tests by patients and physicians and greater likelihood of PSA testing.
Catherine G Mclaughlin - One of the best experts on this subject based on the ideXlab platform.
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the relationship between Health Plan performance measures and physician network overlap implications for measuring Plan quality
Health Services Research, 2010Co-Authors: Daniel D Maeng, Dennis P Scanlon, Tim Gronniger, Walter P Wodchis, Michael E Chernew, Catherine G MclaughlinAbstract:One approach to reforming the Health care system involves creating more competitive Health care markets. Some proposals focus on competition among Health Plans, under the implicit assumption that well-informed purchasers and consumers can choose their Plan based on costs, benefit structure, and quality (Robinson 1999; Scanlon et al. 2005;). As a result, Health Plan performance measurement is common (Bundorf, Choudhry, and Baker 2006), reflecting the assumption that Plans are responsible, at least in part, for the quality of care received by their members. Yet Plan control over quality is limited. Typical measures of Health Plan performance include process measures that likely reflect physician practice style and behavior. To the extent that hospitals and physicians contract with multiple Health Plans, Plans may be less able to distinguish themselves in the marketplace on these measures (Chernew et al. 2004). As such, if the degree of physician overlap is large, comparing Health Plans based on performance measures may not necessarily convey the information that either consumers or policy makers seek about variation in the quality of care, limiting the usefulness of the measures for practical purposes. Thus, the Health Plan may not be the most useful unit for measuring quality of care experienced by consumers. Instead, provider-oriented structures, such as accountable care organizations (ACOs) or medical homes, where the primary responsibility of delivering high-quality care is assumed to rest with the providers, may constitute a step in the right direction toward the goal of creating more meaningful quality metrics (Fisher et al. 2007). Of course, measurement at this more refined level can always be aggregated to the Health Plan level if Plan-level comparisons are desired. In this paper, we empirically explore the extent to which the overlap in Health Plans' physician networks is correlated with Health Plan performance using a unique dataset. Our results indicate that in the presence of a higher degree of provider network overlap, Plan performance measures tend to converge to a lower level of quality. In previous research, Chernew et al. (2004) demonstrated that there is about a fifty–fifty chance that a patient switching a Plan may not need to change his or her physician. Baker et al. (2004) showed that variation in the Healthcare Effectiveness Data and Information Set (HEDIS) scores may be explained by the systematic but unobserved heterogeneity of both providers and Plans, suggesting that providers may indeed affect HEDIS scores.
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the relationship between Health Plan performance measures and physician network overlap implications for measuring Plan quality
Mathematica Policy Research Reports, 2010Co-Authors: Daniel D Maeng, Dennis P Scanlon, Tim Gronniger, Walter P Wodchis, Michael E Chernew, Catherine G MclaughlinAbstract:Examines the extent to which Health Plan quality measures capture physician practice patterns rather than Plan characteristics.
