Quality Varies Across Health Insurance Marketplace Pricing Regions.
| Autor: | MacLean CH; Healthcare Value Solutions Inc., Thousand Oaks †the David Geffen School of Medicine at UCLA, Los Angeles, CA ‡Anthem Inc., Indianapolis, IN §Inovalon Inc., Bowie, MD., Marnoch E, Sun Z, Curtis J, Burmeister J, Anum EA, Belman M, Nussbaum SR |
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| Jazyk: | angličtina |
| Zdroj: | Medical care [Med Care] 2015 Jul; Vol. 53 (7), pp. 607-18. |
| DOI: | 10.1097/MLR.0000000000000367 |
| Abstrakt: | Background: Although consumers purchasing health plans in the new Health Insurance Marketplace will be provided information on the cost and quality of participating health plans, it is unclear whether the state-wide plan quality averages that will be reported will accurately represent quality at the pricing region level where care will be received. Objectives: To evaluate whether currently reported state-wide health plan quality scores accurately represent quality within pricing regions established for the Health Insurance Marketplace. Research Design: Observational, historical cohort study using health plan administrative and pharmacy data. Subjects: A total of 5.2 million members enrolled in the preferred provider organization health plans of 1 large commercial California insurer in 2012. Measures: State-wide and pricing region performance on each of the 17 Healthcare Effectiveness Data and Information Set (HEDIS) measures. Results: Across the 17 measures assessed in each of the 19 pricing regions, scores were statistically different (P<0.05) than the overall plan rate for 176 (54%). Variations in scores across regions were observed for each measure ranging from 6.4-percentage points for engagement in treatment for people with dependence of alcohol or other drugs to 47.2-percentage points for appropriate testing for pharyngitis among children. Conclusions: Quality scores in California vary greatly across geographic regions. Statewide averages may misrepresent the quality of care that consumers are likely to receive within a geographic area making difficult assessments about the value of the health care. |
| Databáze: | MEDLINE |
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