This study examines the relationship between managed care plan clinical performance measures and member satisfaction ratings. Data source is NCQA's Quality Compass 1999 with plan-level information for 228 publicly reporting plans. HEDIS 1999 effectiveness of care(EOC) and access to care domains and CAHPS 2.0 member satisfaction ratings are used. Interstudy data is used to describe HMO competitiveness at the MSA level.
Average EOC and access measures were created by summing the ten and six measures in each domain. The 2 global CAHPS ratings(health plan, and all health care) were analyzed independently.
Descriptive analyses used simple correlations and t test comparisons. For t-test comparisons, plans were divided into two groups: (1) upper quartile and (2) the remainder. Multivariate analyses will examine the effect of clinical performance measures on global member satisfaction ratings, controlling for plan and market characteristics.
10% of plans were in the top quartile for both the average EOC and CAHPS ratings. Plans in top quartile of all health care and health plan ratings had higher scores in all but 1, and all but 2 of the 10 individual EOC measures, respectively. However, there was no difference on the aggregate EOC measure for either of the top CAHPS quartiles. All the individual and summary access measures were significiantly higher in plans in both top CAHPS quartiles.
The results suggesting no consistent relationship between individual and summary clinical performance and member satisfaction has implications for plan report cards for consumers.
Learning Objectives: At the conclusion of this session, participants (1)will be able to discuss recent research regarding quality of care in managed care organizations (2)participants will be able to understand the elements of HEDIS and CAHPS and their relationship to each other (3) participants will understand the policy implications of these findings with respect to reporting information on quality to consumers
Keywords: Health Care Managed Care, Health Care Quality
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: NCQA Quality Compass 1999
with HEDIS 1999 and CAHPS 2.0
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: AHRQ (formerly AHCPR) has sponsored development of CAHPS and NCQA made an independent decison to include it as part of Quality Compass 1999