Association Between Effectiveness of Care Quality Ratings and Insurer Characteristics in the Health Insurance Marketplac
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J Gen Intern Med DOI: 10.1007/s11606-020-06248-5 © Society of General Internal Medicine 2020
INTRODUCTION
The Affordable Care Act (ACA) has enabled millions of individuals to purchase private health plans through the individual marketplace. Enrollees should seek high value care, defined as medical services that are clinically recommended, delivered efficiently, and use resources optimally.1 Recently, the Centers for Medicare and Medicaid Services (CMS) initiated collection and dissemination of plan quality ratings, including those reflecting effectiveness of care, to facilitate consumer decision-making for the 2020 plan year.2 However, little is known about the association of insurer characteristics and effectiveness of care quality ratings. This research examined four effectiveness of care quality ratings out of the 38 selected by CMS in the individual health insurance market and their association with insurer organizational attributes.
METHODS
We used three primary data sources. We linked 2019 CMS Quality Rating System to the Robert Wood Johnson Foundation’s 2019 Plan Participation Tracker data, and the National Association of Insurance Commissioners 2016 data. These data provide information on plans’ non-profit status, Blue Cross Blue Shield Association membership, Preferred Provider Organization (PPO) plan offerings, and classification as predominantly serving the Medicaid managed care segment. Of 195 total insurer-plan type combinations, 185 reported effectiveness of care quality information. We used multivariate linear regression to analyze the association between plans’ effectiveness of care measures and Received February 21, 2020 Accepted September 15, 2020
organizational attributes. Analyses were performed in Stata 15 with standard errors clustered on insurer.
RESULTS
Appropriately testing children for pharyngitis and treatment of children with upper respiratory infections had mean scores of 83.39% (SD 19.18) and 88.96% (SD 10.92), respectively (Table 1). Appropriate use of imaging studies for lower back pain had a mean score of 76.73% (SD 8.07). Appropriate avoidance of antibiotics for adults with acute bronchitis had a mean score of 32.85% (SD 15.35). The adjusted model found non-profit insurers had an 8.66 percentage point higher score for avoiding antibiotic treatment for adults with acute bronchitis (95% CI, 4.51 to 12.82%; P < 0.001) while insurers offering PPOs were associated with a 7.66 percentage point lower score (95% CI, − 12.61 to − 2.71%; P < 0.001) (Table 2). Non-profit insurers were also associated with a 3.77 percentage point higher score (95% CI, 1.40 to 6.14%; P < 0.001) on guideline-concordant use of imaging studies for low back pain, while insurers offering PPOs were associated with a 3.68 percentage point lower rating (95% CI, − 7.11 to − 0.25; P < .05) for the appropriate treatment of pediatric upper respiratory infections. Medicaid managed care insurers had a 3.74 percentage point lower score (95% CI, − 6.85 to − 0.64%; P < 0.02) and Blue Cross Blue Shield Association insurer
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