title: The impact of health plan delivery system organization on clinical quality and patient satisfaction.
abstract: OBJECTIVE
  The purpose of this study was to examine the extent to which measures of health plan clinical performance and measures of patient perceptions of care are associated with health plan organizational characteristics, including the percentage of care provided based on a group or staff model delivery system, for-profit (tax) status, and affiliation with a national managed care firm.
  
  
  METHODS
  Data describing health plans on region, age of health plan, for-profit status, affiliation with a national managed care firm, percentage of Medicare business, total enrollment, ratio of primary care physicians to specialists, HMO penetration, and form of health care delivery system (e.g., IPA, network, mixed, staff, group) were obtained from InterStudy. Clinical performance measures for women's health screening rates, child and adolescent immunization rates, heart disease screening rates, diabetes screening rates, and smoking cessation were developed from HEDIS data. Measures of patient perceptions of care are obtained from CAHPS survey data submitted as Healthplan Employer Data and Information Set, Consumer Assessment of Health Plans 2.0 H.
  
  
  METHODS
  Multivariate regression cross-sectional analysis of 272 health plans was used to evaluate the relationship of health plan characteristics with measures of clinical performance and patient perceptions of care.
  
  
  RESULTS
  The form of delivery system, measured by percent of care delivered by staff and group model systems, is significantly related (p < or = .05) with four of the five clinical performance indices but none of the three satisfaction performance indices. Other variables significantly associated with performance were being geographically located in the Northeast, having nonprofit status, and for patient satisfaction, not being part of a larger insurance company.
  
  
  CONCLUSIONS
  These comparative results provide evidence suggesting that the type of delivery system used by health plans is related to many clinical performance measures but is not related to patient perceptions of care. These findings underscore the importance of the form of the delivery system and the need for further inquiry that examines the relationship between organizational form and performance.
authors.affiliation: School of Public Health, University of California, Berkeley, 140 Warren Hall, Berkeley, CA 94720-7360, USA.
authors.forename: Robin R
authors.initials: RR
authors.lastname: Gillies
authors.forename: Kate Eresian
authors.initials: KE
authors.lastname: Chenok
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Shortell
authors.forename: Gregory
authors.initials: G
authors.lastname: Pawlson
authors.forename: Julian J
authors.initials: JJ
authors.lastname: Wimbush
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006123:Group Practice / Q000458:organization & administration / Q000592:standards; D019538:Health Care Surveys; D006279:Health Maintenance Organizations / Q000458:organization & administration*; D006801:Humans; D017060:Patient Satisfaction; D011787:Quality of Health Care; D014481:United States