CHCS - Center for Health Care Strategies

Improving the quality and cost-effectiveness of publicly financed health care

Strategies for Assessing Health Plan Performance on Chronic Diseases

Selecting Performance Indicators and Applying Health-Based Risk Adjustment

Type:
Resource Papers
Author:
Ann Volpel, John O'Brien, University of Maryland, Baltimore County; Jonathan Weiner, Johns Hopkins University
Published:
March 2005
As Medicaid managed care programs mature, states are looking to refine their methods of measuring and improving the performance of participating health plans. This CHCS Resource Paper serves a guide for Medicaid agencies who want to develop a performance measurement program using administrative data to evaluate the care provided to enrollees with chronic diseases.

It reviews the factors to consider when developing a program and identifies potential performance indicators that are associated with improved medical outcomes. Using encounter data from Maryland's Medicaid program, the report also demonstrates the application of diagnosis-based risk adjustment to performance measurement by profiling six health plans.

Appendices provide details regarding performance measures, plan performance, demographic data, and risk adjustment.
 

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