Health plan resource use: bringing us closer to value-based decisions.

Objective: To examine commercial health plan variation in resource use for members with diabetes and its relationship to the quality of care for these members.

Study Design: Cohort study using National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set data submitted to the NCQA in 2007, reflecting 2006 health plan performance. Data are submitted to the NCQA by plans based on claim and administrative data; medical record data may be used to supplement missing claim data.

Methods: Composite measures for diabetes quality and resource use (total medical care observed-to-expected [O/E] and pharmacy O/E variables) were estimated. Descriptive statistics, Pearson correlations between quality and resource use, and 90% confidence intervals around each health plan's composite quality and resource use results were estimated.

Results: Vast variation was found for both quality and resource use. Medical care resource use has no relationship to quality for diabetes. Pharmacy resource use has a moderate positive relationship to quality.

Conclusions: Measures of resource use, along with measures of quality, can be produced and provide important information about the value of a health plan. Although this analysis did not determine causality, the lack of relationship between quality and resource use suggests that plans could improve quality of care without large increases in resource use or could achieve the same level of quality with less resource use.