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The relationship between health plan performance measures and physician network overlap: implications for measuring
Daniel D Maeng1, Dennis P Scanlon, Michael E Chernew
1The Pennsylvania State University, 504 Ford Building, University Park, PA 16802, USA. ddm12@psu.edu
Health Services Research
|April 21, 2010
Summary
Health plan quality measures often reflect physician practice patterns, not the plan's actual quality improvement efforts. This suggests a need for provider-focused measurement to enhance patient decision-making and performance incentives.
Area of Science:
- Health Services Research
- Quality Measurement
- Healthcare Policy
Background:
- Standard health plan quality measures are widely used to assess performance.
- There is ongoing debate regarding whether these measures truly reflect plan initiatives or physician behaviors.
Purpose of the Study:
- To determine if health plan quality measures capture physician practice patterns or plan characteristics.
- To evaluate the influence of physician network overlap on reported plan quality.
Main Methods:
- Utilized secondary data from four distinct sources, including physician information and quality databases.
- Developed network overlap metrics and employed linear regression to analyze their relationship with plan performance measures.
Main Results:
- Higher physician network overlap was associated with a convergence of plan performance measures toward lower quality levels.
- Findings suggest that quality metrics may be influenced by provider behavior rather than solely by health plan strategies.
Conclusions:
- Current health plan performance measures primarily reflect physician practice patterns.
- Provider-oriented measurement approaches, such as those in accountable care organizations or medical homes, could improve patient decision-making and performance incentives.
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