Address correspondence to Paul D. Cleary, Ph.D., Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034; e-mail: firstname.lastname@example.org. Laura L. Eselius, Ph.D., M.P.H., is with the Deloitte Research, Deloitte Services LP, Boston, MA 02116-5022. Alan M. Zaslavsky, Ph.D., and Haiden A. Huskamp, Ph.D., are with the Department of Health Care Policy, Harvard Medical School, Boston, MA 02115-5899. Susan H. Busch, Ph.D., is with the Yale School of Public Health, New Haven, CT.
Case-Mix Adjustment of Consumer Reports about Managed Behavioral Health Care and Health Plans
Article first published online: 8 SEP 2008
© Health Research and Educational Trust
Health Services Research
Volume 43, Issue 6, pages 2014–2032, December 2008
How to Cite
Eselius, L. L., Cleary, P. D., Zaslavsky, A. M., Huskamp, H. A. and Busch, S. H. (2008), Case-Mix Adjustment of Consumer Reports about Managed Behavioral Health Care and Health Plans. Health Services Research, 43: 2014–2032. doi: 10.1111/j.1475-6773.2008.00894.x
- Issue published online: 12 NOV 2008
- Article first published online: 8 SEP 2008
- Behavioral health;
- case-mix adjustment
Objective. To develop a model for adjusting patients' reports of behavioral health care experiences on the Experience of Care and Health Outcomes (ECHO™) survey to allow for fair comparisons across health plans.
Data Source. Survey responses from 4,068 individuals enrolled in 21 managed behavioral health plans who received behavioral health care within the previous year (response rate=48 percent).
Study Design. Potential case-mix adjustors were evaluated by combining information about their predictive power and the amount of within- and between-plan variability. Changes in plan scores and rankings due to case-mix adjustment were quantified.
Principal Findings. The final case-mix adjustment model included self-reported mental health status, self-reported general health status, alcohol/drug treatment, age, education, and race/ethnicity. The impact of adjustment on plan report scores was modest, but large enough to change some plan rankings.
Conclusions. Adjusting plan report scores on the ECHO survey for differences in patient characteristics had modest effects, but still may be important to maintain the credibility of patient reports as a quality metric. Differences between those with self-reported fair/poor health compared with those in excellent/very good health varied by plan, suggesting quality differences associated with health status and underscoring the importance of collecting quality information.