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Quality Varies Across Health Insurance Marketplace Pricing Regions
Catherine H MacLean1, Eric Marnoch, Zhao Sun
1*Healthcare Value Solutions Inc., Thousand Oaks †the David Geffen School of Medicine at UCLA, Los Angeles, CA ‡Anthem Inc., Indianapolis, IN §Inovalon Inc., Bowie, MD.
Background:
Although consumers purchasing health plans in the new Health Insurance Marketplace will be provided information on the cost and quality of participating health plans, it is unclear whether the state-wide plan quality averages that will be reported will accurately represent quality at the pricing region level where care will be received.
Objectives:
To evaluate whether currently reported state-wide health plan quality scores accurately represent quality within pricing regions established for the Health Insurance Marketplace.
Research Design:
Observational, historical cohort study using health plan administrative and pharmacy data.
Subjects:
A total of 5.2 million members enrolled in the preferred provider organization health plans of 1 large commercial California insurer in 2012.
Measures:
State-wide and pricing region performance on each of the 17 Healthcare Effectiveness Data and Information Set (HEDIS) measures.
Results:
Across the 17 measures assessed in each of the 19 pricing regions, scores were statistically different (P<0.05) than the overall plan rate for 176 (54%). Variations in scores across regions were observed for each measure ranging from 6.4-percentage points for engagement in treatment for people with dependence of alcohol or other drugs to 47.2-percentage points for appropriate testing for pharyngitis among children.
Conclusions:
Quality scores in California vary greatly across geographic regions. Statewide averages may misrepresent the quality of care that consumers are likely to receive within a geographic area making difficult assessments about the value of the health care.
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