The effect of HEDIS measurement of colorectal cancer screening on insurance plans in Pennsylvania

Abstract

Objective: To determine the effect of Healthcare Effectiveness Data and Information Set (HEDIS) measurement of colorectal cancer (CRC) screening on insurance plans in Pennsylvania.

Study design: Natural experiment tracking changes in CRC screening policies.

Methods: Survey data were collected in 2006 on screening policies of 13 Pennsylvania commercial insurers offering 37 plans. All companies that met the inclusion criteria were surveyed. Medical directors answered questions about how HEDIS measures affected plan benefit designs. Responses were analyzed using descriptive statistics.

Results: All companies responded and focused their responses on a particular plan as requested, including 2 health maintenance organizations, 3 point-of-service plans, 2 fee-for-service plans, and 6 preferred provider organizations. The survey results indicated that 39% of plans revised their screening guidelines, 46% established new or updated reminder systems, and 46% established new systems for tracking screening rates. Although only the health maintenance organization plans were linked to HEDIS with formal reporting, all types of plans reported changes that they attributed to the HEDIS measure.

Conclusion: The establishment of the new HEDIS measure on screening for CRC has been associated with changes in health plan policies and practices in Pennsylvania.