PMID- 30586496
OWN - NLM
STAT- MEDLINE
DCOM- 20191126
LR  - 20191126
IS  - 1936-2692 (Electronic)
IS  - 1088-0224 (Linking)
VI  - 24
IP  - 12
DP  - 2018 Dec
TI  - Relationships between provider-led health plans and quality, utilization, and 
      satisfaction.
PG  - 628-632
AB  - OBJECTIVES: To compare healthcare quality, utilization, and patient satisfaction 
      between provider-led health plans (PLHPs) and non-PLHPs. STUDY DESIGN: 
      Observational study of 2016 Medicare Advantage (MA) plans. METHODS: We included 3 
      quality outcomes (MA Star Rating System, Healthcare Effectiveness Data and 
      Information Set [HEDIS] effectiveness aggregate score, and HEDIS access aggregate 
      score), 4 utilization outcomes (HEDIS average procedure rates, discharge rates, 
      inpatient days, and readmission probability), and 1 patient satisfaction outcome 
      (National Committee for Quality Assurance consumer satisfaction rating). We 
      performed regression analysis to compare the 8 selected outcomes between PLHPs 
      and non-PLHPs, controlling for key covariates, including region, profit status, 
      patient risk, and patient-related and provider-related demographics. RESULTS: Our 
      sample included 64 contracts offered by 31 PLHPs (representing 3,197,284 
      enrollees) and 311 contracts offered by 55 non-PLHPs (representing 13,881,210 
      enrollees). Compared with non-PLHPs, in our primary multivariable model, PLHPs 
      were associated with higher star ratings (beta = 0.41; 95% CI, 0.15-0.67), 
      effectiveness scores (beta = 3.11; 95% CI, 1.43-4.80), and patient satisfaction (beta = 
      0.57; 95% CI, 0.30-0.84), and lower procedure rates (beta = -0.47; 95% CI, -0.79 to 
      -0.16). There were no significant differences in access, discharges, inpatient 
      days, and readmission probability. The association between PLHPs and outcomes 
      differed by plan size, nonprofit status, and region. CONCLUSIONS: Receipt of care 
      within a PLHP was associated with improved quality, effectiveness, and patient 
      satisfaction, as well as lower procedure rates. As providers bear increasing 
      financial risk under alternative payment models, there is momentum to integrate 
      healthcare provision and payment through PLHPs. Our results demonstrate the 
      potential of such organizations to deliver high-quality care, although 
      opportunities remain to optimize utilization.
FAU - Parekh, Natasha
AU  - Parekh N
AD  - Division of General Internal Medicine, University of Pittsburgh, 200 Lothrop St, 
      Pittsburgh, PA 15213. Email: nkp10@pitt.edu.
FAU - Hernandez, Inmaculada
AU  - Hernandez I
FAU - Radomski, Thomas R
AU  - Radomski TR
FAU - Shrank, William H
AU  - Shrank WH
LA  - eng
GR  - KL2 TR001856/TR/NCATS NIH HHS/United States
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Am J Manag Care
JT  - The American journal of managed care
JID - 9613960
MH  - Cross-Sectional Studies
MH  - Delivery of Health Care/*methods/standards/statistics & numerical data
MH  - Humans
MH  - Medicare Part C/*organization & administration/standards/statistics & numerical 
      data
MH  - Patient Acceptance of Health Care/*statistics & numerical data
MH  - Patient Satisfaction/*statistics & numerical data
MH  - Quality of Health Care/*organization & administration/standards/statistics & 
      numerical data
MH  - United States
EDAT- 2018/12/27 06:00
MHDA- 2019/11/27 06:00
CRDT- 2018/12/27 06:00
PHST- 2018/12/27 06:00 [entrez]
PHST- 2018/12/27 06:00 [pubmed]
PHST- 2019/11/27 06:00 [medline]
AID - 87819 [pii]
PST - ppublish
SO  - Am J Manag Care. 2018 Dec;24(12):628-632.