National quality monitoring of Medicare health plans: the relationship between enrollees' reports and the quality of clinical care

Med Care. 2001 Dec;39(12):1313-25. doi: 10.1097/00005650-200112000-00007.


Background: The clinical quality of health plans varies. The associations between different measures of health plan quality are incompletely understood.

Objective: To assess the relationships between enrollee reports on the quality of health plans as measured by the Consumer Assessment of Health Plans Study (CAHPS 2.0) survey and the clinical quality of care measured by the Medicare Health Plan Employer Data and Information Set (HEDIS).

Design: Observational cohort study.

Sample: National sample of 233 Medicare health plans that reported data using the CAHPS 2.0 survey and Medicare HEDIS during 1998.

Measures: Five composite measures and four ratings derived from the CAHPS survey and six measures of clinical quality from Medicare HEDIS.

Results: Two composite measures ("getting needed care" and "health plan information and customer service") were significantly associated with most of the HEDIS clinical quality measures. The proportion of enrollees having a personal doctor was also significantly associated with rates of mammography, eye exams for diabetics, beta-blocker use after myocardial infarction, and follow-up after mental health hospitalization. Enrollees' ratings of health plan care were less consistently associated with HEDIS performance. In multivariable analyses, the measure of health plan communication ("health plan information and customer service") was the most consistent predictor of HEDIS performance.

Conclusions: The pattern of associations we observed among some of the measures suggests that the CAHPS survey and HEDIS are complementary quality monitoring strategies. Our results suggest that health plans that provide better access and customer service also provide better clinical care.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Cohort Studies
  • Consumer Behavior
  • Health Benefit Plans, Employee / standards
  • Health Care Surveys
  • Humans
  • Information Services
  • Linear Models
  • Managed Care Programs / standards*
  • Medicare Part C / standards*
  • Quality Assurance, Health Care*
  • Quality Indicators, Health Care*
  • United States