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HEDIS performance trends in Medicare managed care
1tlied@cms.hhs.gov
Health Care Financing Review
|December 26, 2002
Summary
Medicare health plans showed significant performance improvements from 1996 to 1998 across key HEDIS measures, including preventive care and chronic condition management. Plans with lower initial performance drove the majority of these positive trends.
Area of Science:
- Healthcare Management
- Quality Improvement in Healthcare
- Health Services Research
Background:
- Medicare managed care program oversight is crucial for ensuring quality healthcare delivery.
- Health plan performance monitoring is essential for identifying areas of improvement.
Purpose of the Study:
- To analyze performance trends in Medicare managed care health plans between 1996 and 1998.
- To assess changes in specific quality of care measures over time.
Main Methods:
- Cohort analysis at the health plan level.
- Utilized four Health Employer Data and Information Set (HEDIS) measures: adult preventive/ambulatory services, beta blocker treatment post-myocardial infarction, breast cancer screening, and diabetes eye exams.
Main Results:
- Statistically significant improvements were observed across all four HEDIS performance measures.
- Health plans with initially lower performance in 1996 demonstrated the greatest improvements.
Conclusions:
- Medicare managed care plans demonstrated measurable quality improvements during the study period.
- Targeted interventions for underperforming plans can lead to substantial overall quality gains.
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