Predictors of Hedis Performance and Improvement

Abstract

Objective: To identify factors related to an HMO's performance on the standardized HEDIS and CAHPS measures and factors related to improvement in those measures over time.

Study Design: Longitudinal analysis of a four year panel of HEDIS and CAHPS data (calendar year 1998-2001). All plans reporting to NCQA, regardless of their decision to allow the data to be publicly available, were included. 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 Area Resource File, the U.S. Office of Personnel Management, and the U.S. Department of Labor.

Methods: Multivariate growth models were estimated on market demographic and competition variables, as well as health plan characteristics and decisions regarding data collection and reporting.

Principal Findings: Our estimates don't support the hypothesis that greater competition is associated with better performance on the six HEDIS measures examined. HMO penetration is positively related to HEDIS performance for four of the six measures. Health plan characteristics such as plan profit status, model type, reporting method and decision to allow the data to be made publicly available are all significantly related to better HEDIS performance. The growth parameters indicate that the relationship between the covariates and HEDIS performance is stable over time.

Keywords: Managed Care, Health Maintenance Organizations (HMOs), Quality, Performance Measurement, National Committee for Quality Assurance, Health Employer Data and Information Set (HEDIS), Competition, Markets, Profit Status