Comparing Quality of Care Between a Consumer-Directed Health Plan and a Traditional Plan: An Analysis of HEDIS Measures Related to Management of Chronic Diseases

Abstract

A cross-sectional, retrospective medical and pharmaceutical claims data analysis was conducted to determine if Healthcare Effectiveness Data and Information Set (HEDIS) measures related to care for chronic conditions differed between enrollees in a traditional comprehensive major medical plan (CMM) and a consumer-directed health plan (CDHP). Eleven HEDIS measures for 2006 were compared for CMM and CDHP enrollees in a health plan. Measures included care for persons with diabetes, asthma, depression, cardiovascular disease, and low back pain, and for persons taking persistent medications for specific conditions. In the CMM population, 1,238,949 members were eligible to be included; 131,763 members in the CDHP population were eligible. Statistical significance testing was performed. As measured by HEDIS, CDHP enrollees received higher quality of care than did CMM enrollees in areas related to low back pain, and eye exams and nephropathy screening for persons with diabetes. No significant differences were found between CDHP enrollees and CMM enrollees for measures describing medication management for persons with depression and asthma, annual monitoring for persons taking persistent medications, cholesterol management for persons with cardiovascular disease, or HbA1c testing and low-density lipoprotein screening for persons with diabetes. Enrollees in CDHPs who have chronic conditions received care at levels of quality equal to or better than CMM enrollees. The potential for increased financial responsibility in the CDHP plan did not appear to deter those enrollees from pursuing necessary care. Future research should control for the demographic factors thought to influence both selection into a plan design and quality of care.

Lipid Testing in Patients with Rheumatoid Arthritis and Key Cardiovascular-Related Comorbidities: A Medicare Analysis

“…Publically reported quality of care measures, including the Healthcare Effectiveness Data and Information Set (HEDIS) and Physician Quality Reporting Initiative (PQRI), report annual testing rates, a process measure, and lipid management performance, outcomes measures, as a standard of care for patients with diabetes and coronary artery disease (10, 11). Though HEDIS measures generally apply to younger HMO/insurance populations, annual lipid testing rates reach 85% in coronary artery disease and 77% for diabetes (33), clearly exceeding our observed rates of 63%. Reported lipid testing rates in the Medicare population in 2003 were 68–78% for coronary artery disease and diabetes, and even among “general” Medicare patients’ lipid screening approached 55% each year (34–36).…”

Preventive Service Gains from First Contact Access in the Primary Care Home

“…For example, in the prior 12 months, 83% of our sample had received a mammogram, as compared to 77% nationally43; 78% had received a prostate exam, as compared to 50% nationally44; 90% had received a cholesterol test, as compared to 85–88%45; and 63% had received an influenza vaccination, as compared to 50% nationally 46. Even in this relatively well-educated population with excellent continuity of care and high receipt of preventive services, the addition of first-contact accessibility increased the odds of individuals receiving flu shots, prostate exams and cholesterol screening.…”