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Resource Use and Associated Care Effectiveness Results for People With Diabetes in Managed Care Organizations

Brookings Institution, Engelberg Center for Healthcare Reform, Washington, District of Columbia, jroski{at}brookings.edu

Sally Turbyville, MA, MS

National Committee for Quality Assurance (NCQA) Research, Washington, District of Columbia

Dan Dunn, PhD

Ingenix, Edina, Minnesota

Mark Krushat, MPH ScD

WMK Consulting, LLC, Severna Park, Maryland

Sarah Hudson Scholle, DrPH

National Committee for Quality Assurance (NCQA) Research, Washington, District of Columbia

Objective: To examine how resource use varies with care quality for managed care populations with diabetes. Design and methods: Data from 31 commercial health plans (23 health maintenance organizations and 8 preferred provider organizations) were analyzed. Resource use was calculated using medical and pharmacy claims and enrollment data for members with diabetes. A standardized pricing methodology was applied for resource use associated with inpatient, pharmacy, evaluation and management, and procedural services. Quality of care results were calculated for 4 process quality indicators of the Healthcare Effectiveness Data and Information Set (HEDIS) comprehensive diabetes care measure set. Results: Resource use varied more between organizations than quality of care results. Pharmacy resource use was significantly associated with higher quality; inpatient, procedure and surgery, and ambulatory care visit resource use were not significantly associated. Conclusions: Quality and resource use for managed care populations with diabetes may vary considerably and be largely independent factors in health care delivery. Health plans may be able to favorably impact both factors. (Am J Med Qual 2008:23:365-374)

Key Words: cost of care • resource use • efficiency • quality • HEDIS

American Journal of Medical Quality, Vol. 23, No. 5, 365-374 (2008)
DOI: 10.1177/1062860608316180


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