Research Brief
Primary Care Use Among Commercially Insured Adolescents: Evidence From the 2018 Healthcare Effectiveness Data and Information Set

https://doi.org/10.1016/j.amepre.2020.09.013Get rights and content

Introduction

Improving the utilization of preventive care among adolescents is important for achieving individual-level and population-level health goals. The Healthcare Effectiveness Data and Information Set reports data submitted by managed care health plans, capturing a large number of individuals in the U.S.

Methods

Using Healthcare Effectiveness Data and Information Set from 2018, mean performance levels were calculated for 5 preventive care measures among adolescents. Differences in performance between states that use Healthcare Effectiveness Data and Information Set or Health Plan Accreditation and those that use neither were estimated. Analysis was conducted in January–July 2020.

Results

The sample included data from 39 states, with 32 that use Healthcare Effectiveness Data and Information Set or Health Plan Accreditation and 7 that do not. Adolescent vaccination coverage was 28% for the complete human papillomavirus series, 81% for meningococcal, and 88% for tetanus, diphtheria, and acellular pertussis. Access to a primary care practitioner (a 2-year measure) was 91%, and well-care visits (a 1-year measure) were 50%. When compared with states that do not use Healthcare Effectiveness Data and Information Set or Health Plan Accreditation, the mean performance of states that used either Healthcare Effectiveness Data and Information Set or Health Plan Accreditation was statistically significantly higher for 4 of the 5 assessed measures.

Conclusions

Healthcare Effectiveness Data and Information Set measures can help public health officials to monitor progress toward health goals, such as Healthy People 2020, and identify poorly performing health plans and types of preventive services in greatest need of improvement. States using Healthcare Effectiveness Data and Information Set or Health Plan Accreditation were associated with better performance in some adolescent measures, which suggests that health plan accountability may have a role in achieving health outcomes and could be an important area for future research.

Section snippets

INTRODUCTION

The Healthcare Effectiveness Data and Information Set (HEDIS), created by the National Committee for Quality Assurance (NCQA), is a widely used quality assessment tool for managed care health plans. Approximately 191 million individuals are enrolled in health plans in HEDIS.1 Health plans collect performance data from 3 sources: (1) insurance claims, (2) a method combining insurance claims and medical record data, and (3) member and provider surveys. Health plans submit these data to NCQA,

METHODS

The HEDIS 2019 publicly reported data contain performance assessments from 2018. The observation unit is data submitted by insurance companies with commercial managed care health plans. To ensure that the state-level estimates reported in this study were reasonably representative, the authors excluded states where the public reporting levels for companies were <70%. Measures of adolescent immunization status included HPV; meningococcal; and tetanus, diphtheria, and acellular pertussis (Tdap)

RESULTS

Among 332 companies from 39 states (Table 1), Tdap had the highest vaccination coverage (88%), and HPV series completion had the lowest (28%). Access to a PCP, a 2-year measure, was 91%, and well-care visits, a 1-year measure, were 50%. A total of 32 states (292 companies) used HEDIS/HPA, and 7 states (63 companies) did not (Table 2). Comparing the 2 groups, the mean performance of companies in states using HEDIS/HPA was statistically significantly higher among 4 of the 5 measures, including

DISCUSSION

In 4 of the 5 measures, companies in states using HEDIS/HPA exhibited higher utilization of preventive services than companies in states not using HEDIS/HPA. Accountability structures such as HEDIS/HPA may contribute to improved uptake of preventive services by supporting and incentivizing related interventions, such as provider assessment and feedback,7,8 text message reminders to parents,9 or provider reimbursement levels linked to performance data at primary care medical homes.10 A total of

CONCLUSIONS

This study makes several contributions. The reported performance measures can help public health officials monitor progress toward the target levels of vaccination coverage and healthcare access and help identify low-performing health plans that may benefit from technical assistance. The states using HEDIS/HPA show better performance in some measures. Developing, utilizing, and evaluating accountability structures in health insurance and healthcare delivery systems is an area of ongoing research

ACKNOWLEDGMENTS

The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

No financial disclosures were reported by the authors of this paper.

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Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.