Address correspondence to Marc N. Elliott, Ph.D., 1776 Main St., PO Box 2138, Santa Monica, CA 90407; e-mail: firstname.lastname@example.org. Donna O. Farley, Ph.D., Amelia Haviland, Ph.D., and Mary Ellen Slaughter, Ph.D., are with the RAND Corporation, Pittsburgh, PA. Amy Heller, Ph.D., MPH., is with Health Policy Solutions, Bethesda, MD.
Understanding Variations in Medicare Consumer Assessment of Health Care Providers and Systems Scores: California as an Example
Article first published online: 3 JUN 2011
© Health Research and Educational Trust
Health Services Research
Volume 46, Issue 5, pages 1646–1662, October 2011
How to Cite
Farley, D. O., Elliott, M. N., Haviland, A. M., Slaughter, M. E. and Heller, A. (2011), Understanding Variations in Medicare Consumer Assessment of Health Care Providers and Systems Scores: California as an Example. Health Services Research, 46: 1646–1662. doi: 10.1111/j.1475-6773.2011.01279.x
- Issue published online: 6 SEP 2011
- Article first published online: 3 JUN 2011
- Patient experience of care;
- Geographic variations;
Objective. To understand reasons why California has lower Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores than the rest of the country, including differing patterns of CAHPS scores between Medicare Advantage (MA) and fee-for-service, effects of additional demographic characteristics of beneficiaries, and variation across MA plans within California.
Study Design/Data Collection. Using 2008 CAHPS survey data for fee-for-service Medicare beneficiaries and MA members, we compared mean case mix adjusted Medicare CAHPS scores for California and the remainder of the nation.
Principal Findings. California fee-for-service Medicare had lower scores than non-California fee-for-service on 11 of 14 CAHPS measures; California MA had lower scores only for physician services measures and higher scores for other measures. Adding race/ethnicity and urbanity to risk adjustment improved California standing for all measures in both MA and fee-for-service. Within the MA plans, one large plan accounted for the positive performance in California MA; other California plans performed below national averages.
Conclusions. This study shows that the mix of fee-for-service and MA enrollees, demographic characteristics of populations, and plan-specific factors can all play a role in observed regional variations. Anticipating value-based payments, further study of successful MA plans could generate lessons for enhancing patient experience for the Medicare population.