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Consumers' assessments of Medicare managed care plans can distinguish different dimensions of quality of care

The Consumer Assessment of Health Plans Survey (CAHPS®), which was developed initially by the Agency for Healthcare Research and Quality, is now being used by many purchasers of health care, including major employers, purchasing groups, and the Health Care Financing Administration (HCFA), to assess health insurance plans. HCFA recently conducted the Medicare managed care (MMC) implementation of CAHPS® (CAHPS®-MMC), collecting data on over 200 plans.

Harvard University researchers analyzed survey data from 89,419 Medicare beneficiaries enrolled in 212 Medicare managed-care plans who responded to CAHPS®-MMC in 1998. The researchers, who were supported in part by AHRQ (NRSA training grant T32 HS00020), found that the survey distinguished several dimensions of quality of care related to an individual plan or its network of providers.

Among the 85 survey items, MMC-specific items asked about ease of obtaining needed medical equipment; physical, occupational, or speech therapy; home health services; and prescription medicines. Other MMC items concerned advice to quit smoking, flu shots, personal doctor's knowledge about medical decisions, and the health plan's handling of complaints. Four factors explained 75 percent of the variance in survey responses:

  • Interactions around delivery of care in the doctor's office.
  • Customer service from the plan.
  • Access to medical services provided by the plan, such as specialist care or equipment.
  • Advice on health-promoting activities such as diet and smoking cessation.

The delivery composite was most strongly correlated with overall ratings of care, doctor, and specialist, whereas the customer composite was most strongly correlated with overall rating of the plan. The health care delivery composite comprised about 16 items that referred to direct provision of care. These included interactions with doctor, nurse, and office staff (for example, doctor communicates well, spends enough time, and knows patient history, and office staff is helpful and courteous), and access to primary care (for example, getting advice and appointments as soon as wanted). The customer composite contained five questions about member interactions with the health plan, including payments, paperwork, and customer service.

More details are in "Dimensions of consumer-assessed quality of Medicare managed care health plans," by Alan M. Zaslavsky, Ph.D., Nancy D. Beaulieu, Ph.D., Bruce E. Landon, M.D., M.B.A., and Paul D. Cleary, Ph.D., in the February 2000 Medical Care 38(2), pp. 162-174.

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