Classification of health plans based on relative resource use and quality of care.

Objective: To examine variation among commercial health plans in resource use and quality of care for patients with diabetes mellitus or cardiovascular disease.

Study Design: Cohort study using Healthcare Effectiveness Data and Information Set data submitted to the National Committee for Quality Assurance in 2008.

Methods: Composite measures were estimated for diabetes and cardiovascular disease resource use and quality of care. A "value" classification approach was defined. Obtained were descriptive statistics, Pearson product moment correlations between resource use and quality of care, and 90% confidence intervals around each health plan's composite measures of resource use and quality of care. Health plans were classified based on their results.

Results: For patients with diabetes, the correlation between combined medical care services resource use and composite quality of care is negative (-0.201, p = .008); the correlation between ambulatory pharmacy services resource use and composite quality of care is positive (0.162, p = .03). For patients with cardiovascular disease, no significant correlation was found between combined medical care services resource use and composite quality of care (-0.007, p = .94) or ambulatory pharmacy services resource use (0.170, p = .06).

Conclusions: Measures of resource use and quality of care provide important information about the value of a health plan. Although our analysis did not determine causality, the statistically weak or absent correlations between resource use and quality of care suggest that health plans and practices can create higher value by improving quality of care without large increases in resource use or by maintaining the same quality of care with decreased resource use.