Agreement Between HEDIS Performance Assessments in the VA and Medicare Advantage: Is Quality in the Eye of the Beholder?

Amal N Trivedi; Ira B Wilson; Mary E Charlton; Kenneth W Kizer

doi:10.1177/0046958016638804

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Agreement Between HEDIS Performance Assessments in the VA and Medicare Advantage: Is Quality in the Eye of the Beholder?

Journal article

Open access

Agreement Between HEDIS Performance Assessments in the VA and Medicare Advantage: Is Quality in the Eye of the Beholder?

Amal N Trivedi, Ira B Wilson, Mary E Charlton and Kenneth W Kizer

Inquiry (Chicago), Vol.53(1), pp.1-3

2016

DOI: 10.1177/0046958016638804

PMID: 27033565

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Abstract

Medicare Advantage (MA) plans and the Veterans Affairs (VA) health care system assess quality of care using standardized Healthcare Effectiveness Data and Information Set (HEDIS) performance measures. Little is known, however, about the relative accuracy of quality indicators for persons receiving care in more than one health care system. Among Veterans dually enrolled in an MA plan, we examined the agreement between MA and VA HEDIS assessments. Our study tested the hypothesis that private health plans underreport quality of care relative to a fully integrated delivery system utilizing a comprehensive electronic health record. Despite assessing the same individuals using identical measure specifications, reported VA performance was significantly better than reported MA performance for all 12 HEDIS measures. The VA's performance advantage ranged from 9.8% (glycosylated hemoglobin [HbA1c] < 7.0% in diabetes) to 54.7% (blood pressure < 140/90 mm Hg in diabetes). The overall agreement between VA and MA HEDIS assessments ranged from 38.5% to 62.6%. Performance rates derived from VA and MA aggregate data were 1.6% to 14.3% higher than those reported by VA alone. This analysis suggests that neither MA plans nor the VA fully capture quality of care information for dually enrolled persons. However, the VA's system-wide electronic health record may allow for more complete capture of quality information across multiple providers and settings.

Reproducibility of Results

United States Department of Veterans Affairs - standards

United States

Humans

Medicare Part C - statistics & numerical data

Quality of Health Care - standards

Quality Indicators, Health Care - standards

United States Department of Veterans Affairs - statistics & numerical data

Medicare Part C - standards

Details

Title: Subtitle: Agreement Between HEDIS Performance Assessments in the VA and Medicare Advantage: Is Quality in the Eye of the Beholder?
Creators: Amal N Trivedi - Providence VA Medical Center, Providence, RI, USA Brown University, Providence, RI, USA amal_trivedi@brown.edu
Ira B Wilson - Providence VA Medical Center, Providence, RI, USA
Mary E Charlton - The University of Iowa, Iowa City, USA
Kenneth W Kizer - University of California, Davis, USA
Resource Type: Journal article
Publication Details: Inquiry (Chicago), Vol.53(1), pp.1-3
DOI: 10.1177/0046958016638804
PMID: 27033565
NLM abbreviation: Inquiry
ISSN: 0046-9580
eISSN: 1945-7243
Publisher: United States
Language: English
Date published: 2016
Academic Unit: Health Management and Policy; Epidemiology
Record Identifier: 9983996197902771

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