Dimensions of plan performance for sick and healthy members on the Consumer Assessments of Health Plans Study 2.0 survey

BACKGROUND: The quality of health plan care may differ for members in good and poor health. OBJECTIVE: To determine whether reports from sick and healthy members reflect distinct aspects of plan performance. RESEARCH DESIGN: Mean health plan scores were analyzed on the 1998 and 1999 Medicare Managed Care (MMC) Consumer Assessments of Health Plans (CAHPS) surveys, treating responses from sick and healthy members as separate plan measures. Alternative definitions of health were compared and the one that defined groups with the most distinct experiences was selected. Using factor analysis, composites of report items defined for these groups were identified. Mean ratings were regressed on these composites. SUBJECTS: Two hundred ninety thousand seven hundred thirty-nine Medicare managed care beneficiaries from 381 health plan-reporting units. MEASURES: MMC-CAHPS survey responses, including four overall ratings and 30 specific report items. RESULTS: A question about general health status best defined subgroups with distinct experiences. Report items grouped into eight factors: care for healthy members, care for sick members, finding and communicating with a doctor for sick members, plan customer service, plan-provided medical services and equipment, vaccinations, prescriptions, and smoking cessation advice. Ratings by each subgroup were generally most strongly predicted by reports on care for the same subgroup and by customer service and plan-provided services (for ratings of plan) and access to doctors. CONCLUSIONS: Reports from sick and healthy members measure distinct dimensions of health plan quality, especially in the domain of patient care. Distinguishing these dimensions might help in informing consumers and targeting quality improvement efforts. (October 2002)