title: Understanding variations in Medicare Consumer Assessment of Health Care Providers and Systems scores: California as an example.
abstract: OBJECTIVE
  To understand reasons why California has lower Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores than the rest of the country, including differing patterns of CAHPS scores between Medicare Advantage (MA) and fee-for-service, effects of additional demographic characteristics of beneficiaries, and variation across MA plans within California.
  
  
  METHODS
  Using 2008 CAHPS survey data for fee-for-service Medicare beneficiaries and MA members, we compared mean case mix adjusted Medicare CAHPS scores for California and the remainder of the nation.
  
  
  RESULTS
  California fee-for-service Medicare had lower scores than non-California fee-for-service on 11 of 14 CAHPS measures; California MA had lower scores only for physician services measures and higher scores for other measures. Adding race/ethnicity and urbanity to risk adjustment improved California standing for all measures in both MA and fee-for-service. Within the MA plans, one large plan accounted for the positive performance in California MA; other California plans performed below national averages.
  
  
  CONCLUSIONS
  This study shows that the mix of fee-for-service and MA enrollees, demographic characteristics of populations, and plan-specific factors can all play a role in observed regional variations. Anticipating value-based payments, further study of successful MA plans could generate lessons for enhancing patient experience for the Medicare population.
authors.affiliation: RAND Corporation, Pittsburgh, PA, USA.
authors.forename: Donna O
authors.initials: DO
authors.lastname: Farley
authors.forename: Marc N
authors.initials: MN
authors.lastname: Elliott
authors.forename: Amelia M
authors.initials: AM
authors.lastname: Haviland
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Slaughter
authors.forename: Amy
authors.initials: A
authors.lastname: Heller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003953:Diagnosis-Related Groups; D018588:Fee-for-Service Plans; D006302:Health Services Research; D006801:Humans; D006278:Medicare; D020398:Medicare Part C; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D014481:United States