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Health Care Costs and Financing

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Medicare health plans that provide better access to care and customer service also provide better clinical care

Federal regulations mandate that Medicare-participating health plans report data about quality of care using two measurement systems: the Consumer Assessment of Health Plans Study (CAHPS®) survey and the National Committee for Quality Assurance's Health Plan Employer Data and Information Set (HEDIS). The national CAHPS survey summarizes enrollees' perceptions of multiple aspects of health plan access and communication. HEDIS measures the quality of medical and mental health services in Medicare health plans nationwide.

A recent study found that two CAHPS measures—getting needed care and health plan communication (plan information and customer service)—were significantly associated with most of the HEDIS clinical quality measures for a nationally representative sample of Medicare health plans. Enrollees' ratings of care provided through their plans were less consistently associated with HEDIS plan performance. These findings suggest that when health plans provide better access and customer service, they also provide better clinical care. The findings also justify the use of health plan member reports to assess health plans and identify those that offer both better customer service and higher clinical quality.

Finally, these findings suggest that enrollee-focused approaches—for example, reducing copayments for outpatient visits for preventive services—may have more influence on HEDIS performance than clinician-focused quality management approaches (for example, generating reminders for screening services), according to the researchers. They assessed the relationships between enrollee reports on the quality of health plans as measured by the CAHPS survey and the clinical quality of care measured by HEDIS. This study was supported in part by the Agency for Healthcare Research and Quality (HS09205).

See "National quality monitoring of Medicare health plans," by Eric C. Schneider, M.D., M.Sc., Alan M. Zaslavsky, Ph.D., Bruce E. Landon, M.D., M.B.A., and others, in Medical Care 39(12), pp. 1313-1325.

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