Dataset Information

The relationship between health plan performance measures and physician network overlap: implications for measuring plan quality.

ABSTRACT:

Objective

To examine the extent to which health plan quality measures capture physician practice patterns rather than plan characteristics.

Data source

We gathered and merged secondary data from the following four sources: a private firm that collected information on individual physicians and their health plan affiliations, The National Committee for Quality Assurance, InterStudy, and the Dartmouth Atlas.

Study design

We constructed two measures of physician network overlap for all health plans in our sample and linked them to selected measures of plan performance. Two linear regression models were estimated to assess the relationship between the measures of physician network overlap and the plan performance measures.

Principal findings

The results indicate that in the presence of a higher degree of provider network overlap, plan performance measures tend to converge to a lower level of quality.

Conclusions

Standard health plan performance measures reflect physician practice patterns rather than plans' effort to improve quality. This implies that more provider-oriented measurement, such as would be possible with accountable care organizations or medical homes, may facilitate patient decision making and provide further incentives to improve performance.

SUBMITTER: Maeng DD

PROVIDER: S-EPMC2910566 | biostudies-literature | 2010 Aug

REPOSITORIES: biostudies-literature

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Publications

The relationship between health plan performance measures and physician network overlap: implications for measuring plan quality.

Maeng Daniel D DD Scanlon Dennis P DP Chernew Michael E ME Gronniger Tim T Wodchis Walter P WP McLaughlin Catherine G CG

Health services research 20100409 4

<h4>Objective</h4>To examine the extent to which health plan quality measures capture physician practice patterns rather than plan characteristics.<h4>Data source</h4>We gathered and merged secondary data from the following four sources: a private firm that collected information on individual physicians and their health plan affiliations, The National Committee for Quality Assurance, InterStudy, and the Dartmouth Atlas.<h4>Study design</h4>We constructed two measures of physician network overlap ...[more]

PMID: 20403064

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Project description:BACKGROUND:There is significant promise in analyzing physician patient-sharing networks to indirectly measure care coordination, yet it is unknown whether these measures reflect patients' perceptions of care coordination. OBJECTIVE:To evaluate the associations between network-based measures of care coordination and patient-reported experience measures. DESIGN:We analyzed patient-sharing physician networks within group practices using data made available by the Centers for Medicare and Medicaid Services. SUBJECTS:Medicare beneficiaries who provided responses to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey in 2016 (data aggregated by physician group practice made available through the Physician Compare 2016 Group Public Reporting). MAIN MEASURES:The outcomes of interest were patient-reported experience measures reflecting aspects of care coordination (CAHPS). The predictor variables of interests were physician group practice density (the number of physician pairs who share patients adjusting for the total number of physician pairs) and clustering (the extent to which sets of three physicians share patients). KEY RESULTS:Four hundred seventy-six groups had patient-reported measures available. Patients' perception of "Clinicians working together for your care" was significantly positively associated with both physician group practice density (Est (95?%?CI)?=?5.07(0.83,?9.33),?p?=?0.02) and clustering (Est (95?%?CI)?=?3.73(1.01,?6.44),?p?=?0.007). Physician group practice clustering was also significantly positively associated with "Getting timely care, appointments, and information" (Est (95?%?CI)?=?4.63(0.21,?9.06), p?=?0.04). CONCLUSIONS:This work suggests that network-based measures of care coordination are associated with some patient-reported experience measures. Evaluating and intervening on patient-sharing networks may provide novel strategies for initiatives aimed at improving quality of care and the patient experience.

Project description:ImportanceThere has been a growth in the use of performance-based payment models in the past decade, but inherently noisy and stochastic quality measures complicate the assessment of the quality of physician groups. Examining consistently low performance across multiple measures or multiple years could potentially identify a subset of low-quality physician groups.ObjectiveTo identify low-performing physician groups based on consistently low performance after adjusting for patient characteristics across multiple measures or multiple years for 10 commonly used quality measures for diabetes and cardiovascular disease (CVD).Design, setting, and participantsThis cross-sectional study used medical and pharmacy claims and laboratory data for enrollees ages 18 to 65 years with diabetes or CVD in an Aetna health insurance plan between 2016 and 2019. Each physician group's risk-adjusted performance for a given year was estimated using mixed-effects linear probability regression models. Performance was correlated across measures and time, and the proportion of physician groups that performed in the bottom quartile was examined across multiple measures or multiple years. Data analysis was conducted between September 2020 and May 2021.ExposuresPrimary care physician groups.Main outcomes and measuresPerformance scores of 6 quality measures for diabetes and 4 for CVD, including hemoglobin A1c (HbA1c) testing, low-density lipoprotein testing, statin use, HbA1c control, low-density lipoprotein control, and hospital-based utilization.ResultsA total of 786 641 unique enrollees treated by 890 physician groups were included; 414 655 (52.7%) of the enrollees were men and the mean (SD) age was 53 (9.5) years. After adjusting for age, sex, and clinical and social risk variables, correlations among individual measures were weak (eg, performance-adjusted correlation between any statin use and LDL testing for patients with diabetes, r = -0.10) to moderate (correlation between LDL testing for diabetes and LDL testing for CVD, r = .43), but year-to-year correlations for all measures were moderate to strong. One percent or fewer of physician groups performed in the bottom quartile for all 6 diabetes measures or all 4 cardiovascular disease measures in any given year, while 14 (4.0%) to 39 groups (11.1%) were in the bottom quartile in all 4 years for any given measure other than hospital-based utilization for CVD (1.1%).Conclusions and relevanceA subset of physician groups that was consistently low performing could be identified by considering performance measures across multiple years. Considering the consistency of group performance could contribute a novel method to identify physician groups most likely to benefit from limited resources.

Dataset Information

The relationship between health plan performance measures and physician network overlap: implications for measuring plan quality.

Objective

Data source

Study design

Principal findings

Conclusions

Publications

The relationship between health plan performance measures and physician network overlap: implications for measuring plan quality.

Similar Datasets

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