Association Between Provider-Sponsored Health Plan Ownership and Health Insurance Marketplace Plan Quality.
Background: Over 15.3 million Americans relied on the individual health insurance market for health coverage in 2021. Yet, little is known about the relationships between the organizational characteristics of individual market health insurers and quality of coverage, particularly with respect to cli...
| Publicado en: | JGIM: Journal of General Internal Medicine Vol. 37; no. 14; pp. 3603 - 3611 |
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| Autores principales: | , , , |
| Formato: | research Journal Article |
| Publicado: |
Springer Nature
Nov2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=159792612&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 159792612 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 08848734 4BF jtl: JGIM: Journal of General Internal Medicine issn: 08848734 maglogo: N pubinfo: dt: Nov2022 vid: 37 iid: 14 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 159792612 155300901 159792612 NLM35175497 159792612 10.1007/s11606-022-07407-6 NLM35175497 159792612 ppf: 3603 ppct: 8 formats: tig: atl: Association Between Provider-Sponsored Health Plan Ownership and Health Insurance Marketplace Plan Quality. aug: au: Cai, Sih-Ting Anderson, David Drake, Coleman Abraham, Jean M. affil: University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA sug: subj: Health Insurance Exchanges Retrospective Design Insurance, Health United States Insurance Carriers Product Acquisition Scales Ferrans and Powers Quality of Life Index ab: Background: Over 15.3 million Americans relied on the individual health insurance market for health coverage in 2021. Yet, little is known about the relationships between the organizational characteristics of individual market health insurers and quality of coverage, particularly with respect to clinical outcomes.Objective: To examine variation in marketplace insurers' quality performance and investigate how performance varies by insurer organizational characteristics.Design: Retrospective cohort study.Participants: 381 insurer products, representing 184 unique insurers in 50 states in 2019 and 2020.Main Measures: Marketplace plan clinical quality measures reported in the 2019-2020 CMS Plan Quality Rating System dataset and insurer-product organizational attributes identified from several data sources, including non-profit ownership, Blue Cross Blue Shield Association membership, Medicaid focus and whether or not the insurer product is vertically integrated with a provider organization.Key Results: Among the 381 insurer products in this study, 35% are part of a provider-sponsored health plan (PSHP) and 70% of these entities received four stars or above for overall quality performance. Overall, PSHPs exhibited higher quality than non-PSHPs for both clinical quality management (0.36 increased on a 5-point scale; 95% CI = 0.11 to 0.62; P = 0.005) and enrollee experience (0.27; 95% CI = 0.03 to 0.50; P = 0.03) summary indicators. Medicaid focused insurers were associated with lower performance on enrollee experience, plan administration, and various outcomes related to clinical quality.Conclusions: Provider-sponsored health plans in the health insurance marketplaces are associated with higher-quality care, as measured by CMS clinical quality measures. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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