Quality Varies Across Health Insurance Marketplace Pricing Regions
Bibliographic Data
| ID | 9101729 |
|---|---|
| Authors | Catherine H MacLean (0000-0003-2581-189X, University of California, Los Angeles, corresponding author), Eric Marnoch (Anthem (United States)), Zhao Sun (0000-0003-0763-7963, Anthem (United States)), Jennifer Curtis (0000-0001-5584-0099, Anthem (United States)), Jeff Burmeister (Anthem (United States)), Emmanuel A Anum, Michael Belman, Michael J Belman (Anthem (United States)), Samuel R Nussbaum (Anthem (United States)) |
| Year | 2015 |
| Volume | 53 |
| Issue | 7 |
| Pages | 607-618 |
| Publication date | 2015-07-01 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0000000000000367 |
| PMID | 26067884 |
| OpenAlex | W2411160013 |
| Language | EN |
| References cited | 9 |
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
Actuarial science · Business · Economics · Family medicine · Health care · Health plan · Medicare Advantage · Observational study · Purchasing · Quality (philosophy) · Healthcare Policy and Management · Marketing · Medicine · Patient Satisfaction in Healthcare · Pharmacy · Primary Care and Health Outcomes
| Citation velocity | historical |
|---|---|
| Highly cited | No |