VA Captures More Complete Quality Performance Data Compared to Medicare Advantage
Medicare Advantage (MA) plans and the VA healthcare system assess quality of care using standardized Healthcare Effectiveness Data and Information Set (HEDIS) performance measures. However, little is known about the relative accuracy of quality indicators for persons receiving care in more than one healthcare system. Private plans typically generate performance data using insurance claims or abstracted charts, which may fail to capture the entirety of a patient's care compared with VA's comprehensive electronic health record. Investigators in this study examined the agreement between VA and MA quality assessments for a group of dually-enrolled Veterans, testing the hypothesis that private health plans under-report quality of care relative to a fully integrated delivery system utilizing a comprehensive electronic health record. The number of Veterans sampled for measurement by both systems in the same year (2008 or 2009) ranged from 249 for cholesterol control among Veterans with coronary heart disease to 600 for HbA1c testing among Veterans with diabetes.
- Despite assessing the same Veterans using identical performance measure specifications, reported VA performance was significantly better than reported MA performance for all 12 HEDIS measures. For example, VA's performance advantage ranged from 10 percentage points (46% for VA vs. 36% for MA) for HbA1c <7.0% in diabetes to 55 percentage points (80% for VA vs. 25% for MA) for blood pressure <140/90mmHg in diabetes.
- In sensitivity analyses limited to Veterans having at least 10 MA outpatient encounters, VA reported better performance than MA for 11 of 12 measures – ranging from 10 percentage points to 36 percentage points.
- The overall agreement between VA and MA HEDIS assessments ranged from 39% to 63%. Performance rates derived from VA and MA aggregate data were 2 percentage points to 14 percentage points higher than those reported by VA alone.
- Findings suggest that neither Medicare Advantage plans nor VA fully capture quality of care information for dually-enrolled Veterans. However, VA captures significantly more information than MA. This may be attributable to VA's system-wide electronic health record that allows for more complete capture of quality information across multiple providers and settings.
- Investigators did not validate reported performance rates from either healthcare system.
This study was funded by HSR&D. Dr. Trivedi is part of HSR&D's Center of Innovation in Long-Term Services and Supports for Vulnerable Veterans in Providence, RI.
Trivedi AN, Wilson IB, Charlton ME, and Kizer KW. Agreement between HEDIS Performance Assessments in the VA and Medicare Advantage: Is Quality in the Eye of the Beholder? INQUIRY: The Journal of Health Care Organization, Provision, and Financing. March 31, 2016;53.