Quality of Care in a Low-Income Consumer-Driven Health Plan: Assessment of Healthcare Effectiveness Data Information Set (HEDIS) Scores for Secondary Prevention

Abstract

The passage of the Patient Protection and Affordable Care Act of 2010 (PPACA) may create an estimated 16 million new Medicaid enrollees. This underscores the need to develop innovative strategies to provide efficient care to this population without compromising quality. To address concerns that consumer-driven health plans (CDHPs) and cost sharing discourage individuals from seeking needed care, we examined the Healthcare Effectiveness Data Information Set (HEDIS) measures of secondary prevention for a CDHP offered to uninsured, non-Medicaid eligible adults with incomes under 200% of the federal poverty level and compared them to the National Committee for Quality Assurance (NCQA) benchmarks achieved by national Medicaid and commercially insured health plans. Results suggest that the cost-sharing component in the CDHP plan did not deter these low-income enrollees from pursuing or receiving appropriate care when compared to either Medicaid or commercially insured populations. As these results are only descriptive and not statistical measures, further research is needed with comparable populations and more detailed data for hypothesis testing.

Meaningful Use in Chronic Care: Improved Diabetes Outcomes Using a Primary Care Extension Center Model

“…Previous reports have shown better chronic care by coupling QI programs and EHR systems in large integrated organizations [6,7,16], but to our knowledge this is the first report that describes the effect in small, independent, and predominantly rural primary care. The chronic care results attained by PF+cEHR+MU practices exceeded averages for all 3 measures as reported for commercially insured patients and for national Medicaid data [17].…”