title: Case-mix adjustment of consumer reports about managed behavioral health care and health plans.
abstract: OBJECTIVE
  To develop a model for adjusting patients' reports of behavioral health care experiences on the Experience of Care and Health Outcomes (ECHO) survey to allow for fair comparisons across health plans.
  
  
  METHODS
  Survey responses from 4,068 individuals enrolled in 21 managed behavioral health plans who received behavioral health care within the previous year (response rate = 48 percent).
  
  
  METHODS
  Potential case-mix adjustors were evaluated by combining information about their predictive power and the amount of within- and between-plan variability. Changes in plan scores and rankings due to case-mix adjustment were quantified.
  
  
  RESULTS
  The final case-mix adjustment model included self-reported mental health status, self-reported general health status, alcohol/drug treatment, age, education, and race/ethnicity. The impact of adjustment on plan report scores was modest, but large enough to change some plan rankings.
  
  
  CONCLUSIONS
  Adjusting plan report scores on the ECHO survey for differences in patient characteristics had modest effects, but still may be important to maintain the credibility of patient reports as a quality metric. Differences between those with self-reported fair/poor health compared with those in excellent/very good health varied by plan, suggesting quality differences associated with health status and underscoring the importance of collecting quality information.
authors.affiliation: Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA.
authors.forename: Laura L
authors.initials: LL
authors.lastname: Eselius
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
authors.forename: Haiden A
authors.initials: HA
authors.lastname: Huskamp
authors.forename: Susan H
authors.initials: SH
authors.lastname: Busch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001524:Behavioral Medicine; D003258:Consumer Behavior; D005260:Female; D019538:Health Care Surveys; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D020379:Risk Adjustment; D014481:United States; D055815:Young Adult
references.citation: Int J Methods Psychiatr Res. 2003;12(1):22-33
references.pmid: 12830307
references.citation: J Behav Health Serv Res. 2001 Aug;28(3):258-72
references.pmid: 11497022
references.citation: Health Care Financ Rev. 2001 Spring;22(3):109-126
references.pmid: 25372572
references.citation: Health Aff (Millwood). 1999 Sep-Oct;18(5):163-71
references.pmid: 10495604
references.citation: Psychiatr Serv. 2000 Feb;51(2):248-50
references.pmid: 10655013
references.citation: Int J Qual Health Care. 2001 Dec;13(6):481-8
references.pmid: 11769751
references.citation: QRB Qual Rev Bull. 1992 Feb;18(2):53-9
references.pmid: 1574321
references.citation: Ment Health Serv Res. 2004 Mar;6(1):23-32
references.pmid: 15002678
references.citation: Med Care. 2005 Jan;43(1):44-52
references.pmid: 15626933
references.citation: N Engl J Med. 2003 Jun 26;348(26):2635-45
references.pmid: 12826639
references.citation: J Clin Psychiatry. 2001;62 Suppl 6:5-9
references.pmid: 11310818
references.citation: Psychiatr Serv. 1997 Dec;48(12):1553-61
references.pmid: 9406263
references.citation: Med Care. 1993 Jan;31(1):84-94
references.pmid: 8417273
references.citation: Arch Gen Psychiatry. 2004 Apr;61(4):378-86
references.pmid: 15066896
references.citation: Health Serv Res. 2005 Dec;40(6 Pt 2):2162-81
references.pmid: 16316443
references.citation: JAMA. 1997 Nov 19;278(19):1608-12
references.pmid: 9370508
references.citation: J Gen Intern Med. 2001 Dec;16(12):800-8
references.pmid: 11903758
references.citation: Health Care Financ Rev. 2001 Spring;22(3):101-107
references.pmid: 25372460