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Quality of Care in a Low-Income Consumer-Driven Health Plan: Assessment of Healthcare Effectiveness Data Information Set (HEDIS) Scores for Secondary Prevention

Westover, Chad; Arredondo, Patricia H.; Chapa, Griselda; Cole, Evan; Campbell, Claudia R.

The Journal for Healthcare Quality (JHQ): May-June 2014 - Volume 36 - Issue 3 - p 28–34
doi: 10.1111/jhq.12001
Original Articles

Abstract: The passage of the Patient Protection and Affordable Care Act of 2010 (PPACA) may create an estimated 16 million new Medicaid enrollees. This underscores the need to develop innovative strategies to provide efficient care to this population without compromising quality. To address concerns that consumer-driven health plans (CDHPs) and cost sharing discourage individuals from seeking needed care, we examined the Healthcare Effectiveness Data Information Set (HEDIS) measures of secondary prevention for a CDHP offered to uninsured, non-Medicaid eligible adults with incomes under 200% of the federal poverty level and compared them to the National Committee for Quality Assurance (NCQA) benchmarks achieved by national Medicaid and commercially insured health plans. Results suggest that the cost-sharing component in the CDHP plan did not deter these low-income enrollees from pursuing or receiving appropriate care when compared to either Medicaid or commercially insured populations. As these results are only descriptive and not statistical measures, further research is needed with comparable populations and more detailed data for hypothesis testing.

For more information on this article, contact Patricia H. Arredondo

Chad Westover is a former vice president of business development for WellPoint Inc. Medicaid business. He is now president of Molina Healthcare of Utah. He has worked in healthcare with a focus on the Medicaid and CHIP programs for over 20 years in various policy and management roles. He received a master's degree in public administration and Bachelor of Art degrees in political science and Spanish from Brigham Young University.

Patricia H. Arredondo is a program consultant at WellPoint Inc. Medicaid in Thousand Oaks, California. Her current focus is healthcare program management and policy research related to Medicaid and healthcare reform. She is a Ronald E. McNair Scholar and was a selected participant in the Pennsylvania State University Minority in Research Training (MIRT) program to conduct research at the World Health Organization. Ms. Arredondo has a master's in health services administration from the University of Michigan, Ann Arbor and a Bachelor of Arts degree in psychology from the University of California, Irvine.

Griselda Chapa is an epidemiologist who has worked in healthcare for 33 years and in managed care for 20 years. She has a master's in public health from the University of Illinois and a Master of Science in epidemiology from Yale University. Currently, Ms. Chapa is a student in the Executive Doctor of Science program at the Tulane University

School of Public Health and Tropical Medicine in New Orleans, Louisiana and is also the director of reporting and analytics for WellPoint Inc.'s Comprehensive Health Solutions.

Evan Cole is a PhD student in the Department of Global Health Systems and Development at the Tulane University School of Public Health and Tropical Medicine in New Orleans, Louisiana. Mr. Cole received his master's in public health from the University of Minnesota with an emphasis in health policy and administration and was a University of Wisconsin Population Health Fellow where he conducted policy analysis for Wisconsin's Medicaid Program. Currently Mr. Cole conducts research on primary care, health policy, and Medicaid.

Dr. Campbell is a health economist in the Department of Global Health Systems and Development at Tulane University School of Public Health and Tropical Medicine in New Orleans, Louisiana. She currently directs the Executive Doctor of Science Program and teaches health economics at the master's and doctoral level. She has a number of peer-reviewed articles and book chapters including a co-authored textbook, Financial Management in a Managed Care Environment. Her current research concerns the efficiency, effectiveness, and sustainability of quality improvement and patient safety initiatives.

© 2014 National Association for Healthcare Quality
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