title: Quality Varies Across Health Insurance Marketplace Pricing Regions.
abstract: BACKGROUND
  Although consumers purchasing health plans in the new Health Insurance Marketplace will be provided information on the cost and quality of participating health plans, it is unclear whether the state-wide plan quality averages that will be reported will accurately represent quality at the pricing region level where care will be received.
  
  
  OBJECTIVE
  To evaluate whether currently reported state-wide health plan quality scores accurately represent quality within pricing regions established for the Health Insurance Marketplace.
  
  
  METHODS
  Observational, historical cohort study using health plan administrative and pharmacy data.
  
  
  METHODS
  A total of 5.2 million members enrolled in the preferred provider organization health plans of 1 large commercial California insurer in 2012.
  
  
  METHODS
  State-wide and pricing region performance on each of the 17 Healthcare Effectiveness Data and Information Set (HEDIS) measures.
  
  
  RESULTS
  Across the 17 measures assessed in each of the 19 pricing regions, scores were statistically different (P<0.05) than the overall plan rate for 176 (54%). Variations in scores across regions were observed for each measure ranging from 6.4-percentage points for engagement in treatment for people with dependence of alcohol or other drugs to 47.2-percentage points for appropriate testing for pharyngitis among children.
  
  
  CONCLUSIONS
  Quality scores in California vary greatly across geographic regions. Statewide averages may misrepresent the quality of care that consumers are likely to receive within a geographic area making difficult assessments about the value of the health care.
authors.affiliation: *Healthcare Value Solutions Inc., Thousand Oaks †the David Geffen School of Medicine at UCLA, Los Angeles, CA ‡Anthem Inc., Indianapolis, IN §Inovalon Inc., Bowie, MD.
authors.forename: Catherine H
authors.initials: CH
authors.lastname: MacLean
authors.forename: Eric
authors.initials: E
authors.lastname: Marnoch
authors.forename: Zhao
authors.initials: Z
authors.lastname: Sun
authors.forename: Jennifer
authors.initials: J
authors.lastname: Curtis
authors.forename: Jeff
authors.initials: J
authors.lastname: Burmeister
authors.forename: Emmanuel A
authors.initials: EA
authors.lastname: Anum
authors.forename: Michael
authors.initials: M
authors.lastname: Belman
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Nussbaum
mesh_terms: D002140:California; D062265:Health Insurance Exchanges; D006302:Health Services Research; D006801:Humans; D011243:Preferred Provider Organizations / Q000191:economics* / Q000592:standards*; D019984:Quality Indicators, Health Care; D013221:State Health Plans / Q000191:economics* / Q000592:standards*; D014481:United States