Evaluating health plan quality 2: Survey design principles for measuring health plan quality (original) (raw)
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Evaluating health plan quality 3: survey measurement properties
The American journal of managed care
To assess the measurement and scaling properties of survey items designed to measure health plan quality from a physician's perspective. Prospective survey design with multivariate regression analysis. Data were from 3798 physicians representing 23 health plans in 5 regions: Florida, New York, Colorado, Pennsylvania, and Washington. Scale reliability was assessed by using the Cronbach alpha. Generalist and specialist scales were compared with structural equation modeling. Multivariate analysis was used to examine internal validity by testing theoretically based hypotheses. Scales constructed from the data were reliable, were stable across both generalist and specialist physicians, and demonstrated construct validity. Hypotheses about the relationship between physician experiences with a health plan and physician recommendations of the plan were confirmed, supporting construct validity. The items on the survey instrument can be used with confidence to measure health plan quality ...
Evaluating health plan quality 1: A conceptual model
The American journal of managed care
Objective: To develop a theoretical foundation for measuring health plan quality from a physician's perspective. Study Design: Literature review and theory development. Methods: We defined health plan quality as the degree to which health plan management practices increase the likelihood of high-quality care for individuals and populations and addressed the ways in which health plan quality is similar to, and different from, other commonly used quality measures. Based on an assessment of the literature, we proposed a conceptual model that organizes health plan care management practices into a coherent structure for measuring health plan quality. Results: A conceptual model of health plan operation that organizes managerial practices into a structure for measuring health plan quality from a physician's perspective was developed. Conclusion: Health plan quality is distinct from quality of care, and physicians can provide unique, timely, and reliable information about aspects of health plan quality.
Health plan resource use: bringing us closer to value-based decisions
The American journal of managed care, 2011
To examine commercial health plan variation in resource use for members with diabetes and its relationship to the quality of care for these members. Cohort study using National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set data submitted to the NCQA in 2007, reflecting 2006 health plan performance. Data are submitted to the NCQA by plans based on claim and administrative data; medical record data may be used to supplement missing claim data. Composite measures for diabetes quality and resource use (total medical care observed-to-expected [O/E] and pharmacy O/E variables) were estimated. Descriptive statistics, Pearson correlations between quality and resource use, and 90% confidence intervals around each health plan's composite quality and resource use results were estimated. Vast variation was found for both quality and resource use. Medical care resource use has no relationship to quality for diabetes. Pharmacy resource use has a mode...
Health Services Research, 2003
Objective. To estimate the reliability and validity of survey measures used to evaluate health plans and providers from the consumer's perspective. Data Sources. Members (166,074) of 306 U.S. health plans obtained from the National CAHPS s Benchmarking Database 2.0, a voluntary effort in which sponsors of CAHPS s surveys contribute data to a common repository. Study Design. Members of privately insured health plans serving public and private employers across the United States were surveyed by mail and telephone. Interitem correlations and correlations of items with the composite scores were estimated. Planlevel and internal consistency reliability are estimated. Multivariate associations of composite measures with global ratings are also examined to assess construct validity. Confirmatory factor analysis is used to examine the factor structure of the measure. Findings. Plan-level reliability of all CAHPS s 2.0 reporting composites is high with the given sample sizes. Fewer than 170 responses per plan would achieve plan-level reliability of .70 for the five composites. Two of the composites display high internal consistency (Cronbach's alpha 4 5 .75), while responses to items in the other three composites were not as internally consistent (Cronbach's alpha from .58 to .62). A fivefactor model representing the CAHPS s 2.0 composites fits the data better than alternative two-and three-factor models. Conclusion. Two of the five CAHPS s 2.0 reporting composites have high internal consistency and plan-level reliability. The other three summary measures were reliable at the plan level and approach acceptable levels of internal consistency. Some of the items that form the CAHPS s 2.0 adult core survey, such as the measure of waiting times in the doctor's office, could be improved. The five-dimension model of consumer assessments best fits the data among the privately insured; therefore, consumer reports using CAHPS s surveys should provide feedback using five composites.
The Affordable Care Act calls for the U.S. Secretary of Health and Human Services to issue quality improvement reporting requirements for employer group health plans, including self-insured plans, and individual plans, as well as for qualifying plans in health insurance exchanges. Health plans will need to report on their quality improvement activities regarding plan or coverage benefits and provider reimbursement structures that: improve health outcomes, prevent hospital readmissions, improve patient safety and reduce medical errors, and implement wellness and health promotion activities. Mindful of the opportunity to leverage existing plan reporting tools and achieve administrative efficiencies, this report summarizes key features of the eValue8 Health Plan Request for Information, National Committee for Quality Assurance accreditation, and Medicaid's external quality review process. The authors offer the National Quality Strategy as a framework for quality improvement reporting requirements to align efforts among health plans, health care providers, and health care purchasers. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors, officers, or staff. To learn about new Commonwealth Fund publications when they become available, visit the Fund's Web site and register to receive e-mail alerts. Commonwealth Fund pub. no. 1592.
What do physician recommendations of health plans mean?
The American journal of managed care
H ealth plans manage healthcare in a wide variety of ways, such as providing disease management programs, utilization review, initiatives for prevention and for chronic disease management, and physician payment incentives. 1-4 Perceived differences among health plans have led to purchaser, regulator, and consumer measures of health plan performance that allow comparisons among health plans. 5-7 Because of their professional Objective: To examine what determines physician recommendations of health plans and whether their recommendations reflect experiences with specific plans. Study Design: Cross-sectional mail and telephone survey. Participants and Methods: A sample of 11 453 physicians was surveyed from November 2000 to early 2001, and 3798 (2105 generalists, 1693 specialists) responded. After adjusting for ineligibles and duplicates, the response rate was estimated to be between 41% and 45%. Physician respondents were from 23 health plans in 5 regions: Florida, New York, Colorado, Pennsylvania, and Washington. Plans included those serving commercial, Medicare and Medicaid populations and represented group/staff type HMOs, independent practice associations, and preferred provider organizations. Measurements included self-reported experience with 9 health plan care management strategies and ratings of managed care beliefs and satisfaction with pay. Physicians were asked about their willingness to recommend the health plan to a family member or friend, to people with serious illnesses, or to other physicians. Results: Physician recommendations of a health plan were associated with the health plan's care management activities and with the physician's generalized beliefs about managed care and satisfaction with pay. Conclusion: Physician health plan recommendations can reasonably be interpreted as partially reflecting physician experiences with specific plans. Therefore, they can play a role in helping purchasers and consumers compare health plans.
Surveying Consumer Satisfaction to Assess Managed-Care Quality: Current Practices
Health care financing review
Growing interest in using consumer satisfaction information to enhance quality of care and promote informed consumer choice has accompanied recent expansions in managed care. This article synthesizes information about consumer satisfaction surveys conducted by managed-care plans, government and other agencies, community groups, and purchasers of care. We discuss survey content, methods, and use of consumer survey information. Differences in the use of consumer surveys preclude one instrument or methodology from meeting all needs. The effectiveness of plan-based surveys could be enhanced by increased information on alternative survey instruments and methods and new methodological studies, such as ones developing risk-adjustment methods.
Combining health plan performance indicators into simpler composite measures
Health Care Financing Review, 2002
We investigated how the Consumer Assessment of Health Plan Study (CAHPS) survey and the Health Plan Employer Data Information System (HEDIS) measures from Medicare managed care (MMC) plans could be combined into fewer summary performance scores. Four scores summarize most of the variability in these measures, representing (1) care at the doctor's office, (2) customer service and access, (3) vaccinations, and (4) clinical quality measures. These summaries are substantively interpretable, internally consistent, and describe the majority of variation among units in the performance scores analyzed.