For Health Plans, Costs Can Vary Widely Without an Improvement in Quality of Care

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<p>Resource use, or costs, is not always associated with quality of care for people with diabetes enrolled in managed health plans, <a href="/publications/in-the-literature/2008/dec/resource-use-and-associated-care-effectiveness-results-for-people-with-diabetes-in-managed-care-or
">according to a Commonwealth Fund-supported study</a>. Resource use that does not improve quality-of-care outcomes may represent opportunities to improve health system efficiency.<br><br>This study of 31 commercial health plans found wide variations in outcomes and spending--with sometimes great variations from one region to another--even after accounting for differences in quality of care or population health. Resource use was measured for inpatient, pharmacy, evaluation and management, and procedural services. Quality-of-care results were calculated using indicators from the Healthcare Effectiveness Data and Information Set (HEDIS) diabetes measures.<br><br>Total costs for diabetes care for all plans in the study were $1.6 billion; pharmacy services were the largest contributor to overall costs, accounting for about 40 percent. Pharmacy costs also showed the greatest amount of variation across health plans. The authors report that higher pharmaceutical costs were, in fact, significantly associated with higher-quality care.</p>