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Cost sharing and HEDIS performance.

Michael Chernew1, Teresa B Gibson

  • 1Harvard Medical School, USA.

Medical Care Research and Review : MCRR
|June 19, 2008
PubMed
Summary
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Rising patient copayments for doctor visits and prescriptions negatively impact performance on quality measures like HEDIS. This highlights how cost-control strategies can affect healthcare quality metrics.

Area of Science:

  • Health Services Research
  • Health Economics
  • Quality Improvement

Background:

  • Healthcare providers and systems face increasing scrutiny based on performance metrics.
  • Employers and health plans aim to reduce costs by increasing patient out-of-pocket expenses.

Purpose of the Study:

  • To examine the effect of increased copayments on performance on HEDIS measures.
  • To understand the link between financial incentives in plan design and healthcare quality.

Main Methods:

  • Utilized fixed-effect logit models.
  • Assessed the impact of rising copayment rates for physician visits and prescription drugs.

Main Results:

  • Increased copayment rates were associated with lower performance scores on HEDIS measures.

Related Experiment Videos

  • The influence of copayments on performance varied across HEDIS domains and was often modest.

    • Conclusions:

    • Financial aspects of health plan design significantly influence quality performance metrics.
    • Holding providers accountable for performance may be limited when payers influence outcomes.
    • Current HEDIS measures might not fully capture the impact of benefit design changes on quality.