Kyoungrae Jung

Agency characteristics and changes in home health quality after Home Health Compare.

Objective: This study examines the association between home health agency characteristics and quality improvement in home health care after Home Health Compare (HHC), a public-reporting initiative in the Medicare program. Method: We examined the changes in seven quality measures reported in HHC from 2003 to 2007. We used a linear regression model to examine whether quality changes over time differed by agency characteristics. Results: We found improvements in quality after HHC in the indicators that measure patients’ ability to independently manage daily activities; however, the use of emergent care did not change, and hospitalization rates increased during the study period. Agencies with low quality at baseline, not-for-profit or hospital-based agencies, and agencies with longer Medicare tenure showed greater improvement for some quality measures than their counterparts. Discussion: There was large variation in the degree of quality improvement after HHC by quality indicators and by agency characteristics.

The impact of information disclosure on quality of care in HMO markets

OBJECTIVE To examine the impact of voluntary information disclosure on quality of care in Health Maintenance Organization (HMO) markets in the USA. SETTING Commercial HMOs that collected a set of standardized quality meausures, Health Plan Employer Data and Information Set (HEDIS), between 1997 and 2000 in the USA (1062 HMO-years). After collecting the HEDIS data, some HMOs disclosed their HEDIS-quality scores to the public (disclosing HMOs), whereas some HMOs declined to disclose the information (non-disclosing HMOs). DESIGN A secondary data analysis based on 4 years of quality scores of HMOs. The study uses non-disclosing plans as a control group. A treatment-effects model is used to address a potential bias associated with voluntary disclosure decisions by HMOs. MAIN OUTCOME MEASURE(S) The study focuses on 13 HEDIS clinical indicators. On the basis of these indicators, a plan-level composite score and four domain scores were constructed. The four domains are childhood immunizations, treatments/exams for chronic conditions, screening tests and maternity services. RESULTS Public disclosure leads to an increase of 0.72 composite score units, which corresponds to ∼7% points in original quality scale (0-100%). The degree of quality improvement differed by the type of services. CONCLUSIONS Public release of quality information had a significant and positive effect on quality in HMO markets during the earlier years of the voluntary disclosure program; however, the improvement was not universal across all quality measures.

Demand for prescription drugs under non-linear pricing in Medicare Part D

We estimate the price elasticity of prescription drug use in Medicare Part D, which features a non-linear price schedule due to a coverage gap. We analyze patterns of drug utilization prior to the coverage gap, where the “effective price” is higher than the actual copayment for drugs because consumers anticipate that more spending will make them more likely to reach the gap. We find that enrollees’ total pre-gap drug spending is sensitive to their effective prices: the estimated price elasticity of drug spending ranges between

Where would you go for your next hospitalization

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Comparison of statin adherence among beneficiaries in MA-PD plans versus PDPs.

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Competition And Quality In Home Health Care Markets

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