Health plan resource use: bringing us closer to value-based decisions

Area of Science:

• Health Services Research
• Health Economics
• Quality Improvement

Background:

• Commercial health plans exhibit variability in resource utilization for diabetes management.
• Assessing the relationship between resource use and quality of care is crucial for healthcare value.

Purpose of the Study:

• To investigate variations in resource use among commercial health plans for members with diabetes.
• To determine the relationship between resource use and the quality of diabetes care provided.

Main Methods:

• A cohort study utilized 2006 Healthcare Effectiveness Data and Information Set (HEDIS) data from the National Committee for Quality Assurance (NCQA).
• Composite measures for diabetes quality and resource use (medical and pharmacy) were estimated using observed-to-expected (O/E) ratios.
• Descriptive statistics and Pearson correlations analyzed the relationship between quality and resource use.

Main Results:

• Significant variation in both quality of care and resource use was observed across health plans.
• No relationship was found between medical care resource use and diabetes quality.
• A moderate positive relationship was identified between pharmacy resource use and diabetes quality.

Conclusions:

• Health plan performance can be effectively measured using both quality and resource utilization metrics.
• Findings suggest opportunities to enhance diabetes care quality without substantial increases in resource expenditure.
• Potential exists to achieve equivalent quality outcomes with reduced resource consumption.