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Do Employers Know the Quality of Health Care Benefits They Provide? Use of HEDIS Depression Scores for Health Plans
John Robst, Ph.D.; Kathryn Rost, Ph.D.; Donna Marshall, M.B.A.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200534
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Dr. Robst and Dr. Rost are with the Department of Mental Health Law and Policy, University of South Florida, 13301 Bruce B. Downs Blvd., Tampa, FL 33612 (e-mail: jrobst@fmhi.usf.edu). Ms. Marshall is with the Colorado Business Group on Health, Denver.

Copyright © 2013 by the American Psychiatric Association


Objective  Dissemination of health quality measures is a necessary ingredient of efforts to harness market-based forces, such as value-based purchasing by employers, to improve health care quality. This study examined reporting of Healthcare Effectiveness Data and Information Set (HEDIS) measures for depression to firms interested in improving depression care.

Methods  During surveys conducted between 2009 and 2011, a sample of 325 employers that were interested in improving depression treatment were asked whether their primary health plan reports HEDIS scores for depression to the National Committee for Quality Assurance (NCQA) and if so, whether they knew the scores. Data about HEDIS reporting by the health plans were collected from the NCQA.

Results  HEDIS depression scores were reported by the primary health plans of 154 (47%) employers, but only 7% of employers knew their plan’s HEDIS scores. Because larger employers were more likely to report knowing the scores, 53% of all employees worked for employers who reported knowing the scores. A number of structural, health benefit, and need characteristics predicted knowledge of HEDIS depression scores by employers.

Conclusions  The study demonstrated that motivated employers did not know their depression HEDIS scores even when their plan publicly reported them. Measures of health care quality are not reaching the buyers of insurance products; however, larger employers were more likely to know the HEDIS scores for their health plan, suggesting that value-based purchasing may have some ability to affect health care quality.

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Table 1Characteristics of 325 employers that provide health benefits to at least 100 employees
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a Includes up to four benefits offered and paid for by employers (retirement, professional development, short-term disability, and long-term disability benefits)

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b Mean response to five questions: whether the employer’s health benefits philosophy is to play it slow, safe, and sure; whether the health benefits program takes calculated risks; whether the employer is too cautious; whether health benefits managers are willing to take a chance on a good idea; and whether big risks are necessary to keep health benefits ahead of competition. Possible responses range from 1 to 4, with 1 indicating strongly agree; 2, agree; 3, disagree; and 4, strongly disagree. Responses to questions 1 and 3 are reordered, such that higher scores indicate a greater willingness to innovate and take risks.

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c Includes up to 11 programs offered and paid for by employers (employee assistance, return-to-work, disease management, stress reduction, smoking cessation, obesity, prenatal wellness, grief recovery, fitness membership, on-site flu vaccine, and health risk appraisal programs)

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d Mean response to four questions about whether the depressed worker is unable to meet responsibilities to the firm in the short run and in the long run (two questions), whether friction develops between the depressed worker and other workers, and whether treatment costs contribute to increased premiums. Possible responses range from 1 to 4, with 1 indicating never; 2, sometimes; 3, often; and 4, always.

Table Footer Note

e Mean response to four questions about whether the depressed worker is unable to meet responsibilities at home in the short run and in the long run (two questions), whether friction develops between the depressed worker and family or friends, and whether treatment costs contribute to financial problems. Possible responses range from 1 to 4, with 1 indicating never; 2, sometimes; 3, often; and 4, always.

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Table 2Survey results for 419 employers that expressed interest in a study to improve depression treatment in the workforce
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a HEDIS, Healthcare Effectiveness Data and Information Set

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Table 3Logistic regression results for associations between characteristics of 115 employers and knowledge of HEDIS scoresa
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a HEDIS, Healthcare Effectiveness Data and Information Set. Includes only employers that offered health plans that reported HEDIS scores and that reported knowing whether the plan reported scores. Quasilikelihood under the independence model criterion=95.1. The regression used generalized estimating equations.



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