Quality Varies Across Health Insurance Marketplace Pricing Regions. Issue 7 (July 2015)

• Record Type: Journal Article
• Authors: MacLean, Catherine H.; Marnoch, Eric; Sun, Zhao; Curtis, Jennifer; Burmeister, Jeff; Anum, Emmanuel A.; Belman, Michael; Nussbaum, Samuel R.
• Is Part Of: Medical care. Volume 53:Issue 7(2015)
• Publication Date: 2015-07
• Subjects: Economics, Medical -- Periodicals; Insurance, Health -- Periodicals; Santé, Services de -- Administration -- Périodiques; Soins médicaux -- Périodiques; Medical economics -- Periodicals; Health insurance -- Periodicals; Medical economics -- United States -- Periodicals; Health insurance -- United States -- Periodicals; Comprehensive Health Care -- Periodicals; Personal Health Services -- Periodicals; Gezondheidszorg; Économie de la santé -- Périodiques; Santé, Services de -- Périodiques; Health insurance; Medical economics; United States; Periodicals; 362.10973
• DOI: 10.1097/MLR.0000000000000367
• Languages: English
• ISSNs: 0025-7079

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Background:</title> <p>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.</p> </sec> <sec> <title>Objectives:</title> <p>To evaluate whether currently reported state-wide health plan quality scores accurately represent quality within pricing regions established for the Health Insurance Marketplace.</p> </sec> <sec> <title>Research Design:</title> <p>Observational, historical cohort study using health plan administrative and pharmacy data.</p> </sec> <sec> <title>Subjects:</title> <p>A total of 5.2 million members enrolled in the preferred provider organization health plans of 1 large commercial California insurer in 2012.</p> </sec> <sec> <title>Measures:</title> <p>State-wide and pricing region performance on each of the 17 Healthcare Effectiveness Data and Information Set (HEDIS) measures.</p> </sec> <sec> <title>Results:</title> <p>Across the 17 measures assessed in each of the 19 pricing regions, scores were statistically different (<italic>P</italic><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.</p> </sec> <sec> <title>Conclusions:</title> <p>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.</p> </sec> </abstract>