Health Policy
 

Area of Research

Performance Measurement and Assessment of Health Plans

At the PPC, much of our health research focuses on quality of care issues and the performance of public and private health plans. There is significant, ongoing research about evaluating health plans such as Medicaid managed care and other public programs for lower income residents in Iowa. Assessments often include evaluations of the outcomes of care and consumers' perspective of how the plans perform, including access and barriers to care.

The outcome measures used in many studies are adapted from the Healthcare Effectiveness Data and Information Set (HEDIS), developed by the National Committee for Quality Assurance (NCQA). These focus on use of services measures such as well-child visits in the first 15 months of life and inpatient utilization, effectiveness of care measures such as colorectal cancer screening and comprehensive diabetes care, and access measures such as prenatal and postpartum care and adults’ access to preventive/ambulatory health services.

The consumer surveys are frequently adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. CAHPS is part of a national effort to develop a standardized method for providing consumers and purchasers with information about the quality of health plans. Information provided includes unmet need for service such as emergency room and dental care, satisfaction with the primary care provider and health plan, and assessment of health status. The PPC has been a contributing developer of the CAHPS surveys, together with colleagues from RAND, since 1997.

Results from the studies involved in performance measurement and assessment have been provided to state agencies to aid program planning and development. Outcome assessments and performance measures are adapted to unique populations within the state, depending on the programs being assessed. Long-term assessments of the Medicaid program provide an understanding of trends and indicate the stability of measure values. Providing trend data to policymakers helps to inform their decision making in a positive way.