IngentaConnect Case-Mix Adjustment of Consumer Reports about Managed Behavioral ...

Authors: Eselius, Laura L.¹; Cleary, Paul D.²; Zaslavsky, Alan M.³; Huskamp, Haiden A.³; Busch, Susan H.⁴

Source: Health Services Research, Volume 43, Number 6, December 2008 , pp. 2014-2032(19)

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Abstract:

Objective.

To develop a model for adjusting patients' reports of behavioral health care experiences on the Experience of Care and Health Outcomes (ECHO^™) survey to allow for fair comparisons across health plans. Data Source.

Survey responses from 4,068 individuals enrolled in 21 managed behavioral health plans who received behavioral health care within the previous year (response rate=48 percent). Study Design.

Potential case-mix adjustors were evaluated by combining information about their predictive power and the amount of within- and between-plan variability. Changes in plan scores and rankings due to case-mix adjustment were quantified. Principal Findings.

The final case-mix adjustment model included self-reported mental health status, self-reported general health status, alcohol/drug treatment, age, education, and race/ethnicity. The impact of adjustment on plan report scores was modest, but large enough to change some plan rankings. Conclusions.

Adjusting plan report scores on the ECHO survey for differences in patient characteristics had modest effects, but still may be important to maintain the credibility of patient reports as a quality metric. Differences between those with self-reported fair/poor health compared with those in excellent/very good health varied by plan, suggesting quality differences associated with health status and underscoring the importance of collecting quality information.

Keywords: Behavioral health; CAHPS®; case-mix adjustment

Document Type: Research article

DOI: 10.1111/j.1475-6773.2008.00894.x

Affiliations: 1: Deloitte Research, Deloitte Services LP, Boston, MA 02116-5022, 2: Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, 3: Department of Health Care Policy, Harvard Medical School, Boston, MA 02115-5899 and 4: Yale School of Public Health, New Haven, CT

Case-Mix Adjustment of Consumer Reports about Managed Behavioral Health Care and Health Plans