The Effects of Health Plan Performance Measurement and Reporting on Quality of Care for Medicare Beneficiaries
- Presenter:
Chair: Randall Ellis; Discussant: Margaret Byrne Tue June 6, 2006 13:45-15:15 Room 235
Background: Significant resources have devoted to the development and public dissemination of reports comparing the performance of health plans. The objective of these consumer report cards is to improve the quality of healthcare by providing consumers with the information necessary to incorporate quality into their decisions and plans with information on how their performance compares with others. While a number of studies have documented that these report cards have had relatively little effect on consumer choice of plans, relatively few studies have examined their impact on quality of care.
Objectives: The objective of this research is to examine the effect of health plan quality measurement and reporting on the use of measured services by Medicare beneficiaries. We examine how the implementation of mandatory health plan participation in standardized quality measurement and reporting affected the utilization of measured services among Medicare beneficiaries enrolled in these plans as well as those enrolled in traditional Medicare.
Methods: The primary data source for our analysis is the Medicare Current Beneficiary Survey, an annual survey of Medicare beneficiaries conducted by CMS. Using these data, we examine the utilization by Medicare beneficiaries of 4 services that correspond to performance indicators for Medicare Managed Care plans, including mammograms, flu shots, drugs for controlling high blood pressure, and beta blocker after heart attack. We also define a set of control indicator that includes services, such as pap smear, that are similar to, but not included in, the HEDIS performance indicator set. These models provide an empirical test of whether our findings for the performance indicators are due to report cards rather than other unobserved trends in service utilization. We examine the effect of performance measurement by comparing utilization of performance indicators among Medicare beneficiaries enrolled in managed care plans before and after the implementation of mandatory health plan participation, using the Medicare fee-for-service population as a control group. We use data on Managed Care market penetration to test for the impact of selection of beneficiaries across sectors and spillovers from the managed care to the FFS sector on our results.
Results: We find little evidence that the implementation of quality reporting increased rates of either flu shots or mammograms, both performance indicators. While rates of use of these services increased among Medicare Managed Care enrollees after the implementation of mandatory health plan quality reporting, rates of utilization of the performance indicators also increased among Medicare FFS enrollees who were not directly affected by the program.
Conclusions: Our findings to date indicate that the implementation of mandatory health plan quality reporting had little effect on the utilization of two performance indicators among Medicare beneficiaries enrolled in managed care plans. Our analysis will examine two additional performance indicators and also determine whether spillover or selection effects are driving these results.
