Implications of Variation in the Relationships between Beneficiary Characteristics and Medicare Advantage CAHPS Measures

Abstract   OBJECTIVE: To study how differences in quality score adjustments across Medicare Advantage contracts change comparisons for individuals and contracts.   DATA SOURCES: Responses to the Medicare Advantage implementation of the Consumer Assessments of Healthcare Providers and Systems (CAHPS) survey from 2010 to 2014.   STUDY DESIGN: We fit national-and state-level hierarchical models to predict CAHPS scores for individuals and contracts, adjusted for self-reported education, general health, and mental health. We allow the effects of these variables on quality measures to vary across contracts with a hierarchical model.   DATA COLLECTION/EXTRACTION METHODS: We perform secondary data analysis.   PRINCIPAL FINDINGS: For average consumers, standard adjustment is sufficient to represent variation in contract quality standardized to a common population. For people with characteristics far from average, personalized reporting using their characteristics and contract-specific coefficients can substantially change the expected quality measures across contracts. This effect is stronger when comparing among contracts within a state than across all contracts.   CONCLUSIONS: Customized reporting may help consumers select the best Medicare Advantage plan, but policies should protect against unintended consequences. © Health Research and Educational Trust.