Dennis P. Scanlon, Ph.D.
Associate Professor of Health Policy & Administration,Department of Health Policy & Administration, The Pennsylvania State University

HMO Quality Improvement: Importance of Market and HMO Characteristics

January 21, 2005
12:00 - 1:30 PM

Colonial Penn Center Auditorium

Abstract Paper

Dennis Scanlon is Associate Professor of health policy and administration in Penn State's Department of Health Policy & Administration. Dr. Scanlon received his Ph.D. from the University of Michigan and holds a Masters degree in economics from the University of Pittsburgh. Dr. Scanlon received the 2002 John D. Thompson Award for Young Investigators from the Association of University Programs in Health Administration. Dr. Scanlon's research interests include: quality measurement, competition in health insurance markets, public and private sector health care purchasing activities, and consumer information in health care. Dr. Scanlon has authored several articles on health plan quality, performance measurement and quality improvement, competition, purchasing, and consumer choice of health insurance plans. Dr. Scanlon recently completed a federally funded research project examining the state of quality improvement activities at managed care plans, and the degree to which plans are using performance measures for quality improvement activities. Dr. Scanlon is currently working on a five-year program project with researchers at the University of California at San Francisco and the University of Michigan, examining the impact of competition on the quality of care provided by managed care organizations. This project is funded by the Agency for Healthcare Research and Quality. Dr. Scanlon was recently awarded the prestigious Investigator in Health Care Policy Research Award from the Robert Wood Johnson Foundation, to study whether improvements in quality and reductions in medical errors can be driven by private sector health care purchasers. Dr. Scanlon teaches undergraduate and graduate courses at Penn State on Managed Care, Health Economics, and Quantitative Methods for Health Services Research.

Objective: To identify plan and market characteristics related to commercial HMOs' performance and improvement on enrollee satisfaction and chronic care process and outcomes measures.

Study Design: Longitudinal analysis of an unbalanced five-year panel of HEDIS and CAHPS data (calendar years 1998-2002). All plans reporting to NCQA were included regardless of their decision to allow the data to be available publicly. All plans that reported data in at least one year of the panel were included.

Data Sources: Data were obtained from a variety of sources including the National Committee for Quality Assurance (NCQA), Interstudy, the American Hospital Association (AHA), the Area Resource File (ARF), the U.S. Office of Personnel Management (OPM), and the U.S. Department of Labor (DOL).

Methods: Multivariate growth models were estimated for fourteen HEDIS chronic care outcome and process measures and for the CAHPS overall health plan rating. Models were estimated as a function of market characteristics (e.g., HMO and hospital competition and HMO penetration) and HMO characteristics (e.g., HMO profit status and model type).

Principal Findings: The model estimates do not support the hypothesis that greater competition is consistently associated with better performance for the chronic care measures. HMO penetration, on the other hand, is positively related to HEDIS performance for ten of the fourteen chronic care measures. Health plan characteristics such as plan profit status, model type, HEDIS reporting method and plans' decisions to allow their data to be made publicly available are generally all associated with better performance. The growth parameters indicate little systematic deviation from the average trajectory, except for plans that report their data publicly, which experience greater than average quality improvement on 6 of the fourteen chronic care measures.

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