The Effects of Health Plan Performance Measurement on Quality of ...

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The Effects of Health Plan Performance Measurement on Quality of Care for Medicare Beneficiaries Presented by Kate Bundorf Co-creators: Laurence Baker and Kavita Choudhry AcademyHealth Annual Research Conference June 27, 2006 This venture got bolster from the National Institute on Aging (AG023557 ) and the Agency for Healthcare Research and Quality (KO2 HS11668).

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Background Health mind supplier "report cards" are seen as an apparatus to enhance nature of care. Permit purchasers to make tradeoffs amongst cost and quality when picking among suppliers. Make motivations for suppliers to enhance nature of care. Medicare has been at the front line of endeavors to spread data about supplier quality. NCQA has been the key driver of activities to quantify wellbeing arrangement quality. The Medicare program started requiring Medicare oversaw mind arrangements to submit Medicare HEDIS information as of January 1997

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Have Health Plan Report Cards Improved Quality of Care? Do purchasers utilize the data? Wellbeing arrangement report cards have smallly affected wellbeing arrangement enlistment in the business populace (Chernew, et. al. 2001; Beaulieu, 2002; Scanlon et. al, 2002; Wedig and Tai-Seale, 2002; Jin and Sorenson, 2005). Wellbeing arrangement report cards in the Medicare program have moved enlistment from lower to higher quality arrangements; yet Enrollment shifts have been driven by measures of purchaser fulfillment instead of measures of procedures of care (Dafny and Dranove 2006). Do suppliers utilize the data? Healing facilities reacted to the execution of compulsory report cards even without confirmation that patients were utilizing the data (Dranove, Kessler, et. al. 2003). HEDIS execution pointers are broadly utilized by wellbeing arrangements to actualize and screen quality change programs (Perry 2000; Scanlon, Darby, et. al. 2001).

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Have Health Plan Report Cards Improved Quality of Care? Execution on the markers among arrangements taking an interest in HEDIS has enhanced after some time (NCQA 2002; Lied and Sheingold 2001; Trivedi, Zaslavsky, et. al. 2005). These patterns are not really proof of a causal impact: No control bunch Improvements in execution could be driven by enhancements in estimation Changes in usage could be because of changing arrangement enlistment After controlling for these issues in the business populace, execution upgrades are less sensational (Bundorf and Baker 2006).

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Study Design Compare usage of measured administrations between Medicare oversaw mind enrollees and different recipients prior and then afterward the execution of compulsory quality reporting. Utilize oversaw mind piece of the overall industry in the recipients' province to control for both determination of recipients crosswise over segments and overflows from oversaw care to the FFS part.

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Data Sources 1993-1999 Medicare Current Beneficiary Survey (MCBS) Annual review of around 12,000 Medicare recipients led by CMS. Examine test incorporates non-regulated recipients >=65 living in a metropolitan territory. 1993-1999 Medicare Managed Care Market Penetration Report from CMS.

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Performance Indicators

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Utilization of execution pointers among Medicare oversaw mind enrollees

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Utilization of execution markers with respect to different recipients

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Model Estimation Model 1: Unadjusted contrast in-distinction gauge Compare the distinction between recipients enlisted in oversaw mind arranges and those selected in FFS prior and then afterward the usage of obligatory quality reporting for Medicare oversaw mind arranges (controlling for time patterns normal to all recipients). Display 2: Control for choice in light of detectable qualities Controls incorporate age, sex, instruction, conjugal status, race, ethnicity, self-reported history of 16 conditions, self reported wellbeing status, number of ADLs, BMI markers, smoking status, and district altered impacts. Display 3: Control for determination and overflow impacts utilizing oversaw mind piece of the pie factors Spillover and choice impacts: oversaw mind share Selection impacts: oversaw mind share*HMO enrollee Difference amongst pre-and post-intercession periods in overflow and choice impacts: Interaction of every variable with a marker of the mediation time frame

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Results for Mammogram

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Results for Beta Blocker

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Results for Flu Shot

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Results for Eye Exams for Diabetics

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Summary of Results Rates of use of the execution pointers we contemplated did not build more quickly among Medicare HMO enrollees than recipients enlisted in customary Medicare consequent to the usage of required quality reporting. The absence of a beneficial outcome of value providing details regarding usage of execution measures among HMO enrollees is not delicate to controlling for either determination of enrollees over the areas or overflows from quality reporting exercises to the FFS part. Usage rates of beta blockers expanded all the more quickly for FFS recipients in business sectors with large amounts of oversaw care entrance in the post-reporting period.

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Implications The execution of required wellbeing arrangement quality estimation and reporting did not expand usage of execution measures among Medicare oversaw nurture the administrations we contemplated. Report cards did not make sufficiently solid motivating forces for arrangements to enhance their execution. Quality change projects were set up in HMOs serving the business populace before the execution of obligatory support by the Medicare program. Markers we contemplated are not those that were probably going to have demonstrated change. Quality reporting by HMOs may have had positive overflow impacts on the Medicare FFS populace.

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Research Question Did the execution of compulsory wellbeing arrangement interest in institutionalized execution estimation and reporting enhance nature of care among enrollees in Medicare Managed Care arranges?

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Health Plan Performance Measurement in Medicare In 1996, HCFA contracted with NCQA to create HEDIS measures for Medicare oversaw mind arranges. HCFA started obliging arrangements to submit Medicare HEDIS information as of January 1997. In 1998, CMS propelled . In 1999, HEDIS measures got to be accessible on the site.

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Model Estimation Model 1: Unadjusted contrast in-distinction gauge where i lists people, m files regions, t files years (1993-1999) Y is a paired pointer of usage of administration; H is a marker of enlistment in a Medicare oversaw mind arrange; I is a marker of whether required quality reporting had been executed amid the day and age; and Z incorporates year altered impacts Model 2: Control for determination in light of discernible attributes Controls incorporate people attributes (age, sex, instruction, conjugal status, race, ethnicity, self-reported history of 16 conditions, self reported wellbeing status, number of ADLs, BMI pointers, and smoking status) and region settled impacts. Demonstrate 3: Control for choice and overflow impacts utilizing piece of the overall industry factors

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Identifying Selection and Spillover Effects (Model 3)