Abraham Jean Marie, Cai Sih-Ting, Anderson David, Drake Coleman
Division of Health Policy and Management, University of Minnesota, Minneapolis (Abraham); Department of Health Policy and Management, University of Pittsburgh, Pittsburgh (Cai, Drake); Duke University Margolis Center for Health Policy, Durham, North Carolina (Anderson).
Psychiatr Serv. 2021 Feb 1;72(2):200-203. doi: 10.1176/appi.ps.202000115. Epub 2020 Dec 18.
Using 2019 Centers for Medicare and Medicaid Services data, the authors analyzed performance on behavioral health care quality measures among 168 marketplace insurers offering 185 products and investigated whether performance differed by insurer attributes.
The authors considered four quality measures: antidepressant medication management, follow-up care for children prescribed attention-deficit hyperactivity disorder medication, follow-up care within 7 days after hospitalization for mental illness, and initiation and engagement of alcohol and other drug dependence treatment. Multivariate regression was used to determine whether performance varied by insurers' nonprofit ownership, Blue Cross-Blue Shield affiliation, Medicaid-managed care participation, and preferred provider organization status.
Performance levels were highest for management with antidepressant medication and lowest for initiation and engagement of drug dependence treatment. Systematic differ-ences were observed by ownership status and Medicaid-managed care plan status.
Increasing the transparency of health plan quality information is important for aiding enrollee decision making and encouraging quality improvement among providers and insurers.
作者利用2019年医疗保险和医疗补助服务中心的数据,分析了提供185种产品的168家市场保险公司在行为健康护理质量指标方面的表现,并调查了表现是否因保险公司属性而异。
作者考虑了四项质量指标:抗抑郁药物管理、为开具注意力缺陷多动障碍药物的儿童提供后续护理、精神疾病住院后7天内的后续护理,以及酒精和其他药物依赖治疗的启动和参与情况。使用多元回归来确定表现是否因保险公司的非营利性所有权、蓝十字蓝盾附属关系、医疗补助管理式护理参与情况以及优选提供者组织地位而有所不同。
抗抑郁药物管理的表现水平最高,药物依赖治疗的启动和参与情况的表现水平最低。观察到所有权状态和医疗补助管理式护理计划状态存在系统性差异。
提高健康计划质量信息的透明度对于帮助参保人做出决策以及鼓励提供者和保险公司提高质量非常重要。