Abstract
BackgroundThere is a push towards quality measures in health care. As a consequence, the National Committee for Quality Assurance (NCQA) has been publishing insurance plan quality measures.ObjectiveThe objective of this study was to examine the relationship between insurance plan quality measures and the participating providers (doctors).MethodsWe collected and analyzed provider and insurance plan data from several online sources, including provider directories, provider referrals and awards, patient reviewing sites, and hospital rankings. The relationships between the provider attributes and the insurance plan quality measures were examined.ResultsOur analysis yielded several findings: (1) there is a moderate Pearson correlation (r=.376) between consumer satisfaction insurance plan scores and review ratings of the member providers, (2) referral frequency and provider awards are negligibly correlated to consumer satisfaction plan scores (correlations of r=.031 and r=.183, respectively), (3) there is weak positive correlation (r=.266) between the cost charged for the same procedures and consumer satisfaction plan scores, and (4) there is no significant correlation between member specialists’ review ratings and specialty-specific insurance plan treatment scores for most specialties, except a surprising weak negative correlation for diabetes treatment (r=-.259).ConclusionsOur findings may be used by consumers to make informed choices about their insurance plans or by insurances to understand the relationship between patients’ satisfaction and their network of providers.
Highlights
States and the federal government are partnering to better integrate medical, behavioral, and long-term services and supports (LTSS) for individuals dually eligible for Medicare and Medicaid
The available literature and expert opinion emphasized that a cornerstone of high-quality integrated care for people with medical, behavioral, and long-term services and supports (LTSS) needs is a dynamic person/family-centered plan of care built on significant individual/caregiver involvement and comprehensive assessments and reassessments over time to capture changes in people’s circumstances and preferences.[7,8,9,10]
The culture of the health plan should reflect a commitment to integrated care
Summary
Through Commonwealth Fund support, PRIDE was launched in 2012 by the VNSNY Research Center. When a search of the literature turned up scant information, the project staff developed their own framework, drawing on available literature, the input of experts and advocates, and advice from a National Advisory Group convened for one year to develop and launch the PRIDE initiative (Exhibit 1).[6]. The available literature and expert opinion emphasized that a cornerstone of high-quality integrated care for people with medical, behavioral, and long-term services and supports (LTSS) needs is a dynamic person/family-centered plan of care built on significant individual/caregiver involvement and comprehensive assessments and reassessments over time to capture changes in people’s circumstances and preferences.[7,8,9,10] Other key ingredients consistently identified were: 1. Financial incentives aligned across service providers that reward high performance consistent with the “Triple Aim”11 – improving population care, improving the patient experience, and reducing cost
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