title: Health plan resource use: bringing us closer to value-based decisions.
abstract: OBJECTIVE
  To examine commercial health plan variation in resource use for members with diabetes and its relationship to the quality of care for these members.
  
  
  METHODS
  Cohort study using National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set data submitted to the NCQA in 2007, reflecting 2006 health plan performance. Data are submitted to the NCQA by plans based on claim and administrative data; medical record data may be used to supplement missing claim data.
  
  
  METHODS
  Composite measures for diabetes quality and resource use (total medical care observed-to-expected [O/E] and pharmacy O/E variables) were estimated. Descriptive statistics, Pearson correlations between quality and resource use, and 90% confidence intervals around each health plan's composite quality and resource use results were estimated.
  
  
  RESULTS
  Vast variation was found for both quality and resource use. Medical care resource use has no relationship to quality for diabetes. Pharmacy resource use has a moderate positive relationship to quality.
  
  
  CONCLUSIONS
  Measures of resource use, along with measures of quality, can be produced and provide important information about the value of a health plan. Although this analysis did not determine causality, the lack of relationship between quality and resource use suggests that plans could improve quality of care without large increases in resource use or could achieve the same level of quality with less resource use.
authors.affiliation: National Committee for Quality Assurance, Washington, DC, USA. sturbyville@qualityforum.org
authors.forename: Sally Elizabeth
authors.initials: SE
authors.lastname: Turbyville
authors.forename: Meredith B
authors.initials: MB
authors.lastname: Rosenthal
authors.forename: L Gregory
authors.initials: LG
authors.lastname: Pawlson
authors.forename: Sarah Hudson
authors.initials: SH
authors.lastname: Scholle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003657:Decision Making; D003920:Diabetes Mellitus; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006285:Health Planning / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D018570:Risk Assessment; D013223:Statistics as Topic; D014481:United States; D055815:Young Adult