David J. Knutson

Consumer responses to health plan report cards in two markets.

BACKGROUND Health plans can compete on quality when consumers have helpful information. Report cards strive to meet this need, but consumer responses have not been measured. OBJECTIVES The objectives of this study were (1) to compare consumer responses to report cards in 2 markets, (2) to determine how personal characteristics relate to exposure, and (3) to assess the perceived helpfulness of the report cards. RESEARCH DESIGN A postenrollment survey was used. SUBJECTS The study included 784 employees of Monsanto (St Louis, 1996) and 670 employees of a health care purchasing cooperative (Denver, 1997). DEPENDENT MEASURES The dependent measures were (1) exposure, specifically remembering the report card, and intensity of reading it and (2) perceived helpfulness in learning about plan quality and in deciding to stay or switch. RESULTS Except for remembering seeing the report card (Denver, 47%; St Louis, 55%), the 2 groups did not differ. Forty percent read most or all of the report card; 82% found the report helpful in learning about quality; and 66% found it helpful in deciding to stay or switch. Employees who used patient survey information in their plan decision were more likely to remember seeing the report card (odds ratio [OR], 4.85), to read it intensely (OR, 2.84), and to find it helpful in learning about plan quality (OR, 3.04) and deciding whether to stay or switch plans (OR, 2.64). CONCLUSIONS Although the 2 samples differed markedly, their responses to report cards were similar. Exposure and helpfulness were related more to employee preferences for the type of information than to their health care decision needs.

Physician Pay‐For‐Performance

Recent research underscores the gaps that exist between evidence-based medical practices and the care that many patients actually receive. Recognizing this, large purchasers are experimenting with new reimbursement arrangements called pay-for-performance (P4P) that tie a portion of payments for physician services to measures of quality. Agency theory, from the discipline of economics, provides a perspective on the challenges P4P is likely to encounter. The focus of most P4P initiatives on medical group performance raises additional questions about its potential effectiveness as a catalyst for change.SummaryThe literature to date on the impact of P4P initiatives is, understandably, quite limited. The relative newness of P4P creates an opportunity to think carefully about the type of research needed to truly understand its impact on the practice of medicine. In particular, the influence of organizational characteristics on the ultimate impact of P4P needs to be understood through carefully constructed research projects. This requires a conceptual framework that melds insights from the economics and organizational change literatures with detailed knowledge of medical care processes. The challenges in conducting successful interdisciplinary research of this type are many, but such research is required to fully assess the impact of P4P on improve medical care in America.

Variation in Diabetes Care Quality Among Medicare Advantage Plans Understanding the Role of Case Mix

This study investigates whether variation in Medicare Advantage plan performance on comprehensive diabetes care is explained by the case mix of plans. Using data on 513 Medicare Advantage plan-year observations for 2007 and 2008, the authors estimate multivariate regressions for 3 diabetes care quality measures: (1) hemoglobin screening, (2) low-density lipoprotein screening, and (3) retinal eye exam. Plan case mix is measured with the percentage of a plan’s enrollees who have type 1 diabetes with and without comorbidities and the percentage of a plan’s enrollees who have type 2 diabetes with and without comorbidities. Plans with a higher percentage of enrollees with type 1 diabetes with comorbidity and plans with a higher percentage of enrollees with type 2 diabetes without comorbidity have lower performance, on average. Finding evidence of a relationship between case mix and Healthcare Effectiveness Data and Information Set performance reinforces the argument for developing standardized risk adjustment or stratification methods in public reporting and pay-for-performance efforts.

How do urban organized health care delivery systems link with rural providers

Organized delivery systems are becoming an increasingly important component of urban health care markets and are expanding their influence in rural areas as well. They also are developing new linkages with rural providers. This article, based on the experiences of 20 diverse organizations, identifies and describes the strategies being used by urban systems to redefine linkages with rural hospitals and, particularly, physicians.