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Evaluating the Impact of Value-Based Purchasing: A Guide for Purchaser

A Guide for Purchasers

Managing HEDIS® Measures Through Aggregation

To address the issue of multiple measures, some purchasers combine multiple HEDIS® measures into one overall score or a smaller number of scores representing fewer dimensions, such as prevention, access, and surgical care. They then use these aggregated scores to compare plans to each other, or to compare a specific plan's performance from one period to the next.

To create these dimensions, or categories, one could assign weights to selected HEDIS® measures and group those measures into domains of performance either using ad hoc methods or factor analytic approaches. The exact weight for each of the measures in a domain would reflect organizational objectives and perhaps scientific literature regarding the importance of the measure in affecting health. Once the weights are determined, each plan or provider can receive a score based on its relative performance. This approach is similar to the strategy that some purchasers use to combine individual health plan performance measures into consumer-friendly categories for reporting purposes.

The advantage of this approach is that it allows for the many HEDIS® measures to be collapsed into a smaller subset. The disadvantage is that this approach masks the heterogeneity of the individual HEDIS® measures and makes it difficult to identify specific areas for improvement. For more on reporting categories, go to Scanlon et al., 2001; and https://talkingquality.ahrq.gov.

 

A Quick Look at CAHPS®. CAHPS®, sponsored by AHRQ, is a family of survey instruments designed to obtain consumer assessments about the quality of the health care services they receive. The core survey contains about 50 standard items that focus on multiple dimensions of the care and services provided by health plans, including getting needed care, getting care quickly, doctor's communication skills, courteousness and helpfulness of staff and customer service and other domains. CAHPS® instruments have been developed and tested for adults and children who are covered by commercial insurers, Medicare and Medicaid. Supplemental items have also been developed to identify and obtain data on the care provided for children and adults with chronic conditions. Other supplemental sets include items on interpreter services and transportation. Though CAHPS® was originally designed for consumer assessment of health plans, an upcoming version has been developed to obtain consumer assessment of providers within group practices. CAHPS® II (beginning in 2002) will also focus on use of CAHPS® information for quality improvement purposes.

The CAHPS® Survey and Reporting Kit contains complete instructions for implementation of the surveys, templates for reporting results to consumers, instructions for data analysis, and other issues such as presenting CAHPS® results to the media.

Like HEDIS®, the CAHPS® survey includes standardized questions and specific protocols for administering the survey so that each plan's results can be compared to the performance of other plans nationally, regionally, or locally. As noted, the NCQA has incorporated the CAHPS® composite measures into its data reporting requirements for HEDIS®. With the exception of the ratings of care and health plan services, most of the CAHPS® items are not direct measures of the other final outcomes discussed in this guide. However, research findings suggest that most of the CAHPS® measures are correlated with some of these outcomes, most likely health status and labor market outcomes. To the extent that CAHPS® captures the quality and appropriateness of clinical care, for example, the survey results would be correlated with health status. Similarly, since CAHPS® asks for enrollees' opinions about their health care plans, these results may be related to labor market outcomes. For example, if employees report that they are happy with their health care plans, one might expect lower employee turnover, although other factors can also lead to turnover.

Because CAHPS® is comprised of so many items, the use of CAHPS® for assessing the impact of VBP activities faces barriers similar to those discussed above for HEDIS®. Namely, individual items have to be aggregated in order to be useful. However, the CAHPS® developers have conducted considerable research regarding the appropriate aggregation of CAHPS® measures and issued guidelines for purchasers and others to follow (CAHPS® 2.0, 1999). In addition, because CAHPS® asks plan enrollees about the care and services of their health plans, the results may not be relevant to specific VBP activities that are more provider-oriented. This issue may be resolved by the upcoming introduction of G-CAHPS® (group-level CAHPS®), which focuses on consumers' experiences with physicians and medical practices.

To obtain the CAHPS® Survey and Reporting Kit free-of-charge, or to learn more about CAHPS®, contact the CAHPS® Survey Users Network (SUN) at 1-800-492-9261 or at http://www.cahps-sun.org. The SUN also provides limited technical assistance.

 

Task 3: Analyze the Data

For most evaluations, the analyst is not the same individual or group of individuals who made the initial decision to embark on the evaluation. In many cases, the purchaser may wish to contract with external consultants or individuals affiliated with academic institutions to assist in the analysis. This is particularly true for more complex analyses that require statistical expertise and familiarity with methods and software for conducting experimental and observational research. Outside analysts also offer the benefit of objectivity, since they have no stake in the results of their research.

Ideally, the analysts should be involved in all of the steps outlined in this guide, particularly in the choice of research design and issues of data collection and measurement, but in practice this is not always the case. Regardless of whether the analysts have been involved in the development and planning of the evaluation, it is important that they understand the details of the VBP program, the short-term and long-term objectives of the purchaser, and how the purchaser hopes to use the findings so that the analysis will result in information that is germane and useful.

 

Step 5. Summarize the Results and Interpret Implications for Purchasing Activities

Once the analysis has produced evidence regarding the impact of VBP activities on relevant outcomes, the next step is to ensure that those findings are communicated in a way that is helpful to you, and potentially to the larger community of value-based purchasers and health services researchers. For this to happen, the purchaser must first make sure that the analysts do not simply hand over hundreds of pages of output from regression models. Rather, the analysts should be directed to present senior-level management with a succinct list of key results and findings that are pertinent to the overarching goals and objectives of the organization. This document would be similar in concept to a legal brief or one-page business memo, both of which are designed to facilitate quick and accurate decisionmaking.

The second part of this step is to use these findings to draw out the implications for the VBP activity; this task may be performed by the analysts or by the purchaser. However, in practice, this work is often neglected or forgotten. In some cases, the results of an evaluation never make it to this step because of problems with the research or how the findings have been communicated (e.g., when analysts provide senior-level decisionmakers with information that is voluminous, too confusing to understand, or impossible to sort through). But purchasers need to determine what the results of the analysis mean for the VBP activity: whether it is working, where it is failing, whether and how it can be refined. Ultimately, this is the step where the transition from analysis to decisionmaking occurs, using the results of the VBP evaluation as the bridge.

The final task, of course, is for the purchaser to incorporate the results of the VBP evaluation into decisions. Because all organizations have different structures and processes for making decisions, and because information from the evaluation is just one of many inputs, this guide does not delve into this topic. However, purchasers are strongly encouraged to involve key stakeholder groups in discussing how to interpret and use the results. A key principle of "utilization-focused" evaluation (i.e., an evaluation that is attempting to produce results that will be useful to specific audiences) is that people outside of the evaluation team need to be involved in discussions of draft results and in decisions that derive from those results.

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References

Babbie E. The Practice of Social Research, 8th ed. Belmont, CA: Wadsworth Publishing Company; 1998.

Bailey DM. Research for the Health Professional: A Practical Guide, 2nd ed. Philadelphia, PA: F.A. Davis Company; 1997.

Battistella R, Burchfield D. The Future of Employment-Based Health Insurance. Journal of Healthcare Management 2000;45(1):46-57.

Buchmueller TC, Feldstein P. The Effect of Price on Switching Among Health Plans. Journal of Health Economics 1997, 16(2):231-47.

CAHPS® 2.0 Survey and Reporting Kit. Rockville, MD: Agency for Health Care Policy and Research; 1999. AHRQ Publication No. 99-0039.

Campbell DT, Stanley JC. Experimental and Quasi-Experimental Designs for Research. Dallas, TX: Houghton Mifflin Company; 1963.

Castles AG, Milstein A, Damberg CL. Using Employer Purchasing Power to Improve the Quality of Perinatal Care. Pediatrics 1999;103(1):248-54.

Ceniceros R. Employees Bear More Costs. Business Insurance 2001;35(43):3,44.

Donahue JG, Weiss ST, Livingston JM et al., Inhaled Steroids and the Risk of Hospitalization for Asthma. Journal of the American Medical Association 1997;277(11):887-91.

Dowd BE, Finch M. Employers as Catalysts for Health Care Quality: Theory and Practice [mimeo]. Division of Health Services Research and Policy, University of Minnesota. Prepared for an Agency for Healthcare Research and Quality conference, "Understanding How Employers Can Be Catalysts for Quality: Insights for a Research Agenda," April 4, 2001, Washington, DC; 2001.

Dudley RA, Bae RY, Johansen KL et al., When and How Should Purchasers Seek to Selectively Refer Patients to High Quality Hospitals? Prepared for a National Academy of Sciences workshop, "Interpreting the Volume-Outcome Relationship in the Context of Health Care Quality," May 11, 2000, Washington, DC; 2000.

Farley DO, Short PF, Elliot MN et al., Effects of CAHPS® Health Plan Performance Information on Plan Choices by New Jersey Medicaid Beneficiaries. Health Services Research 2002 (in press).

Feldman R, Christianson J, Schultz J. Do Consumers Use Information to Chose a Health-Care Provider System? The Milbank Quarterly 2000;78:1,47-77.

Feldstein PJ. Health Care Economics, 4th ed. Albany, NY: Delmar Publishers; 1993.

Fink A. Evaluation Fundamentals: Guiding Health Programs, Research and Policy. Newbury Park, CA: Sage Publications; 1993.

Fossett JW, Goggin M, Hall JS et al., Managing Medicaid Managed Care: Are States Becoming Prudent Purchasers? Health Affairs 2000;19(4):36-49.

Fraser I, McNamara P, Lehman G et al., The Pursuit of Quality by Business Coalitions: A National Survey. Health Affairs 1999;18(6):158-65.

Gabel J, Levitt L, Pickreign J et al., Job-Based Health Insurance in 2001: Inflation Hits Double Digits, Managed Care Retreats. Health Affairs 2001;20(5):180-6.

Gold MR, Siegel JE, Russell LB et al., Eds. Cost-Effectiveness in Health and Medicine. New York, NY: Oxford University Press; 1996.

Kohn LT, Corrigan JM, Donaldson MS, Eds. To Err Is Human: Building a Safer Health System. Washington, DC: Committee on Quality of Health Care in America, Institute of Medicine; 2000.

Leapfrog Group. Fact Sheet. Washington, DC; 2001. Available at: http://www.leapfroggroup.org/FactSheets/LF_FactSheet.pdf

Levit K, Smith C et al., Inflation Spurs Health Spending in 2000. Health Affairs 2002;21(1):172-81.

Lipson D, De Sa J. Impact of Purchasing Strategies on Local Health Care Systems. Health Affairs 1996;15(2):62-76.

Meyer J, Rybowski L, Eichler R. Theory and Reality of Value-Based Purchasing: Lessons from the Pioneers. Rockville, MD: Agency for Health Care Policy and Research; 1997. AHCPR Publication No. 98-0004.

Meyer JA, Wicks EK, Rybowski LS et al., Report on Report Cards: Initiatives of Health Coalitions and State Government Employers to Report on Health Plan Performance and Use Financial Incentives. vol. I. Washington, DC: Economic and Social Research Institute; 1998.

Meyer JA, Wicks EK, Rybowski LS et al., Report on Report Cards: Initiatives of Health Coalitions and State Government Employers to Report on Health Plan Performance and Use Financial Incentives. vol. II. Washington, DC: Economic and Social Research Institute; 1999.

Midwest Business Group on Health, Juran Institute, The Severyn Group. Reducing the Costs of Poor Quality Health Care Through Responsible Purchasing Leadership. [Draft]. Chicago, IL: Midwest Business Group on Health; 2002.

Milstein RL, Wetterhall SF et al., Framework for Program Evaluation. Morbidity and Mortality Weekly Report 1999, 48(No. RR-11).

Patton MQ. Utilization-Focused Evaluation, 3rd ed. Thousand Oaks, CA: Sage Publications; 1997.

Quality vs. Costs? A Survey of Healthcare Purchasing Habits and Concerns. Healthcare Financial Management 2000;54(7):68-72.

QualityMetric Incorporated. SF-36® Health Survey. Lincoln, RI; 2001. http://www.qmetric.com

Ragin CC. The Distinctiveness of Case-oriented Research. Health Services Research 1999;34(5; Part II):1137-51.

Robinow A. Ensuring Health Care Quality: A Purchaser's Perspective—A Health Care Coalition. Clinical Therapeutics 1997;19(6):1545-54.

Rodriguez T, Schauffler H. Exercising Purchasing Power for Preventive Care. Health Affairs 1996;15(1):73-85.

Sakala C. Medically Unnecessary Caesarean Section Births: Introduction to a Symposium. Social Science and Medicine 1993;37(10):1177-98.

Scanlon DP, Chernew M, McLaughlin C et al., The Impact of Health Plan Report Cards on Managed Care Enrollment. Journal of Health Economics 2002;21(1):19-42.

Scanlon DP, Darby C, Rolph, E et al., The Role of Performance Measures for Improving Quality in Managed Care Organizations. Health Services Research 2001;36(3):619-41.

Schauffler HH, Brown C, Milstein A. Raising the Bar: The Use of Performance Guarantees by the Pacific Business Group on Health. Health Affairs 1999;18(2):134-42.

Schultz J, Thiede Call K, Feldman R et al., Do Employees Use Report Cards to Assess Health Care Provider Systems? Health Services Research 2001;36(3):509-30.

Shortell S, Richardson WC. Health Program Evaluation. Saint Louis, MO: Mosby; 1978.

Sofaer S. Qualitative Methods: What Are They and Why Use Them? Health Services Research 1999;34(5; Part II):1101-18.

Uhrig JD. Beneficiaries' Use of Quality Reports for Choosing Medicare Health Plans. [Ph.D. Dissertation]. The Pennsylvania State University; 2001.

Wennberg JE, Gittelsohn A. Small Area Variations in Health Care Delivery. Science 1973;82(117):1102-8.

Yeaton W, Camberg L. Program Evaluation for Managers. Boston, MA: Management Decision and Research Center, Health Services Research and Development Services, Office of Research and Development, Department of Veterans Affairs; 1997.

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Selected Resources and Web Sites for Purchasers' Quality Improvement Activities

In addition to this guide, AHRQ has several other resources that may be helpful for purchasers seeking to improve the quality of health care. The Web sites listed below provide more information about these resources.

AHRQ Quality Indicators (QIs)

The AHRQ QIs software is a set of measures of health care quality that is designed for use in conjunction with hospital administrative data to highlight potential quality concerns, identify areas that need further study and investigation, and track changes over time. More details on the AHRQ Quality Indicators are available at http://www.qualityindicators.ahrq.gov.

CONQUEST

CONQUEST (COmputerized Needs-oriented QUality Measurement Evaluation SysTem) is quality improvement software that draws on two databases—one for clinical performance measures and one for conditions. CONQUEST helps users identify, understand, compare, evaluate, and select measures to assess and improve clinical performance.

CAHPS®

CAHPS® is an easy-to-use kit of survey and report tools that provides reliable and valid information to help consumers and purchasers assess and choose among health plans and providers. All CAHPS® products are available from the CAHPS® Survey Users Network at http://www.cahps-sun.org.

National CAHPS® Benchmarking Database (NCBD)

Initiated in 1998, the NCBD provides benchmarks to facilitate comparisons across health plans by users of the CAHPS® survey. Users can access the database at http://ncbd.cahps.org.

Making Health Care Safer: A Critical Analysis of Patient Safety Practices

This evidence report, compiled by AHRQ's , reviews the evidence on a total of 79 patient safety practices. Making Health Care Safer: A Critical Analysis of Patient Safety Practices describes 11 practices that the researchers considered highly proven to work but which are not performed routinely in the Nation's hospitals and nursing homes. The report is available online at http://www.ahrq.gov/clinic/ptsafety/ or in printed format from the AHRQ Publications Clearinghouse.

National Guideline Clearinghouse™ (NGC)

The National Guideline Clearinghouse is a comprehensive database that provides objective, detailed information on evidence-based clinical practice guidelines at http://www.guideline.gov.

TalkingQuality Web Site

Launched in March 2002, the TalkingQuality Web site provides easy-to-use information on health care quality at https://talkingquality.ahrq.gov. The site is sponsored by AHRQ, CMS, and the U.S. Office of Personnel Management.

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Bibliography

Academy for Health Services Research and Health Policy. http://www.academyhealth.org/

Agency for Healthcare Research and Quality: Reauthorization Fact Sheet. Rockville, MD: Agency for Healthcare Research and Quality; 1999. AHRQ Publication No. 00-P002. Available at: http://www.ahrq.gov/about/ahrqfact.htm

AHRQ Profile: Quality Research for Quality Healthcare. Rockville, MD: Agency for Healthcare Research and Quality; 2000. AHRQ Publication No. 00-P005. Available at: http://www.ahrq.gov/about/profile.htm

American Evaluation Association. 2001. http://www.eval.org

Babbie E. The Practice of Social Research, 8th ed. Belmont, CA: Wadsworth Publishing Company; 1998.

Bailey DM. Research for the Health Professional: A Practical Guide, 2nd ed. Philadelphia, PA: F.A. Davis Company; 1997.

Bailit M. Ominous Signs and Portents: A Purchaser's View of Health Care Market Trends. Health Affairs 1997;16(6):85-8.

Battistella R, Burchfield D. The Future of Employment-Based Health Insurance. Journal of Healthcare Management 2000;45(1):46-57.

Bodenheimer T, Sullivan, K. How Large Employers Are Shaping the Health Care Marketplace. New England Journal of Medicine 1998;338(15):1084-7.

Brand R, Dudley R, Johansen K et al., Selective Referral to High-Volume Hospitals. Journal of the American Medical Association 2000;283(9):1159-65.

Buchmueller TC, Feldstein P. The Effect of Price on Switching Among Health Plans. Journal of Health Economics 1997;16(2):231-47.

Burke B. Evaluating for a Change: Reflections on Participatory Methodology. New Directions for Evaluation 1998;80:43-56.

CAHPS® 2.0 Survey and Reporting Kit. Rockville, MD: Agency for Health Care Policy and Research; 1999. AHRQ Publication No. 99-0039.

Campbell DT, Stanley JC. Experimental and Quasi-Experimental Designs for Research. Dallas, TX: Houghton Mifflin Company; 1963.

Carroll S, Meyer J, Rybowski L et al., Employer Coalition Initiatives in Health Care Purchasing (vols. I and II). Washington, DC: Economic and Social Research Institute; 1996.

Castles AG, Milstein A, Damberg CL. Using Employer Purchasing Power to Improve the Quality of Perinatal Care. Pediatrics 1999;103(1):248-54.

Ceniceros R. Employees Bear More Costs. Business Insurance 2001;35(43):3,44.

Christianson J, Feldman R, Weiner J et al., Early Experience with a New Model of Employer Group Purchasing in Minnesota. Health Affairs 1999;18(6):100-14.

Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: Institute of Medicine; 2001.

CONQUEST Fact Sheet. COmputerized Needs-Oriented QUality Measurement Evaluation SysTem. Rockville, MD: Agency for Health Care Policy and Research; 1999. AHCPR Publication No. 99-P001. Available at: http://www.ahrq.gov/qual/conquest/conqfact.htm

 

Donahue JG, Weiss ST, Livingston JM et al., Inhaled Steroids and the Risk of Hospitalization for Asthma. Journal of the American Medical Association 1997;277(11):887-91.

Donaldson M. Accountability for Quality in Managed Care. Journal on Quality Improvement 1998;21(12):711-25.

Dowd BE, Finch M. Employers as Catalysts for Health Care Quality: Theory and Practice [mimeo]. Division of Health Services Research and Policy, University of Minnesota. Prepared for an Agency for Healthcare Research and Quality conference, "Understanding How Employers Can Be Catalysts for Quality: Insights for a Research Agenda," April 4, 2001, Washington, DC; 2001.

Dudley RA, Bae RY, Johansen KL et al., When and How Should Purchasers Seek to Selectively Refer Patients to High Quality Hospitals? Prepared for a National Academy of Sciences workshop, "Interpreting the Volume-Outcome Relationship in the Context of Health Care Quality," May 11, 2000, Washington, DC; 2000.

Farley DO, Short PF, Elliot MN et al., Effects of CAHPS® Health Plan Performance Information on Plan Choices by New Jersey Medicaid Beneficiaries. Forthcoming in Health Services Research 2002 (in press).

Feldman R, Christianson J, Schultz J. Do Consumers Use Information to Chose a Health-Care Provider System? The Milbank Quarterly 2000;78:1,47-77.

Feldstein PJ. Health Care Economics, 4th ed. Albany, NY: Delmar Publishers; 1993.

Fink A. Evaluation Fundamentals: Guiding Health Programs, Research and Policy. Newbury Park, CA: Sage Publications; 1993.

Fossett JW, Goggin M, Hall JS et al., Managing Medicaid Managed Care: Are States Becoming Prudent Purchasers? Health Affairs 2000;19(4):36-49.

Fraser I, McNamara P. Employers: Quality Takers or Quality Makers? Medical Care Research and Review 2000;57(2):33-52.

Fraser I, McNamara P, Lehman G et al., The Pursuit of Quality by Business Coalitions: A National Survey. Health Affairs 1999;18(6):158-65.

Gabel J, Levitt L, Pickreign J et al., Job-Based Health Insurance in 2001: Inflation Hits Double Digits, Managed Care Retreats. Health Affairs 2001;20(5):180-6.

Gabel J, Ginsburg P, Hart K. Small Employers and Their Health Benefits, 1988-1996: An Awkward Adolescence. Health Affairs 1997;16(5):103-10.

Galvin RS. An Employer's View of the U.S. Health Care Market. Health Affairs 1999;19(1):166-70.

Gold MR, Siegel JE, Russell LB et al., Eds. Cost-Effectiveness in Health and Medicine. New York, NY: Oxford University Press; 1996.

Grimaldi P. How Purchasers Evaluate Health Plans. Nursing Management 1997;28(10):31-2.

Healthcare Cost and Utilization Project (HCUP), 1988-97: A Federal-State-Industry Partnership in Health Data. Rockville, MD: Agency for Healthcare Research and Quality; 2000. Available at: http://www.ahrq.govhttp://www.hcup-us.ahrq.gov/overview.jsp

Johns Hopkins University. The Johns Hopkins ACG Case-Mix System. Baltimore, MD; 2001. http://www.acg.jhsph.edu

Kamlet M. The Comparative Benefits Modeling Project: A Framework for Cost Utility Analysis of Government Health Care Programs. Office of Disease Prevention and Health Promotion, Public Health Service, U.S. Department of Health and Human Services, Washington, DC; 1992.

Keller J. Business Coalition Initiatives Related to Behavioral Healthcare Purchasing and Quality Improvement. Behavioral Healthcare Tomorrow 1995;4(4):49-52.

Kohn LT, Corrigan JM, Donaldson MS, Eds. To Err Is Human: Building a Safer Health System. Washington, DC: Committee on Quality of Health Care in America, Institute of Medicine; 2000.

Leapfrog Group. Fact Sheet. Washington, DC; 2001. Available at: http://www.leapfroggroup.org/FactSheets/LF_FactSheet.pdf

Legnini M, Perry M, Robertson N et al., Where Does Performance Measurement Go From Here? Health Affairs 2000;19(3):173-7.

Levit K, Smith C et al., Inflation Spurs Health Spending in 2000. Health Affairs 2002;21(1):172-81.

Lipson D, De Sa J. Impact of Purchasing Strategies on Local Health Care Systems. Health Affairs 1996;15(2):62-76.

Lo Sasso AT, Perloff L, Schield J et al., Beyond Cost: "Responsible Purchasing" of Managed Care by Employers. Health Affairs 1999;18(6):212-23.

Mandelblatt JS, Fryback DG, Weinstein MC et al., Assessing the Effectiveness of Health Interventions. In: Cost-Effectiveness in Health and Medicine. New York, NY: Oxford University Press, pp. 135-75; 1996.

Marquis M, Long SH. Who Helps Employers Design Their Health Insurance Benefits? Health Affairs 2000;19(1):133-8.

McGee J, Kanouse D, Sofaer S et al., Making Survey Results Easy to Report to Consumers: How Reporting Needs Guided Survey Design in CAHPS®. Medical Care 1999;37(3):MS32-40, supplement.

Meyer J, Rybowski L, Eichler R. Theory and Reality of Value-Based Purchasing: Lessons from the Pioneers. Rockville, MD: Agency for Health Care Policy and Research; 1997. AHCPR Publication No. 98-0004.

Meyer JA, Wicks EK, Rybowski LS et al., Report on Report Cards: Initiatives of Health Coalitions and State Government Employers to Report on Health Plan Performance and Use Financial Incentives. vol. I. Washington, DC: Economic and Social Research Institute; 1998.

Meyer JA, Wicks EK, Rybowski LS et al., Report on Report Cards: Initiatives of Health Coalitions and State Government Employers to Report on Health Plan Performance and Use Financial Incentives. vol. II. Washington, DC: Economic and Social Research Institute; 1999.

Midwest Business Group on Health, Juran Institute, The Severyn Group. Reducing the Costs of Poor Quality Health Care Through Responsible Purchasing Leadership. [Draft]. Chicago, IL: Midwest Business Group on Health; 2002.

Milstein RL, Wetterhall SF et al., Framework for Program Evaluation. Morbidity and Mortality Weekly Report 1999;48(No. RR-11).

Patton MQ. Utilization-Focused Evaluation, 3rd ed. Thousand Oaks, CA: Sage Publications; 1997.

Quality Interagency Coordination Task Force (QuIC). Fact Sheet. AHRQ, Rockville, MD: Agency for Healthcare Research and Quality; 2001. AHRQ Publication No. 00-P027. Available at: http://www.ahrq.gov/qual/quicfact.htm

Quality Measurement Advisory Service (QMAS). Arm in Arm: A Guide to Implementing a Coordinated Quality Measurement Program. Seattle, WA: Foundation for Health Care Quality; 1999.

Quality Measurement Advisory Service (QMAS). Measuring Health Care Quality for Value-Based Purchasing; 1997. http://www.qmas.org/tools/guide-management/26total.htm

Quality Measurement Advisory Service (QMAS). Organizing and Financing a Health Care Quality Measurement Initiative: A Guide For Getting Started; 1996. http://www.qmas.org/tools/guide-organizing/16total.htm

Quality vs. Costs? A Survey of Healthcare Purchasing Habits and Concerns. Healthcare Financial Management 2000;54(7):68-72.

QualityMetric Incorporated. SF-36® Health Survey. Lincoln, RI; 2001. http://www.qmetric.com

Ragin CC. The Distinctiveness of Case-oriented Research. Health Services Research 1999;34(5; Part II):1137-51.

Reinertsen J. Collaborating Outside the Box: When Employers and Providers Take on Environmental Barriers to Guideline Implementation. Journal on Quality Improvement 1995;21(11):612-8.

Robinow A. Ensuring Health Care Quality: A Purchaser's Perspective—A Health Care Coalition. Clinical Therapeutics 1997;19(6):1545-54.

Rodriguez T, Schauffler H. Exercising Purchasing Power for Preventive Care. Health Affairs 1996;15(1):73-85.

Rossi PH, Freeman HE, Lipsey MW. A Systematic Approach, 6th ed. Newbury Park, CA: Sage Publications; 1999.

Sakala C. Medically Unnecessary Caesarean Section Births: Introduction to a Symposium. Social Science and Medicine 1993;37(10):1177-98.

Scanlon DP, Chernew M, McLaughlin C et al., The Impact of Health Plan Report Cards on Managed Care Enrollment. Journal of Health Economics 2002;21(1):19-42.

Scanlon DP, Darby C, Rolph, E et al., The Role of Performance Measures for Improving Quality in Managed Care Organizations. Health Services Research 2001;36(3):619-41.

Schauffler HH, Brown C, Milstein A. Raising the Bar: The Use of Performance Guarantees by the Pacific Business Group on Health. Health Affairs 1999;18(2):134-42.

Schultz J, Thiede Call K, Feldman R et al., Do Employees Use Report Cards to Assess Health Care Provider Systems? Health Services Research 2001;36(3):509-30.

Shortell S, Richardson, WC. Health Program Evaluation. Saint Louis, MO: Mosby; 1978.

Smith VK, Des Jardins T, Peterson KA. Exemplary Practices in Primary Care Case Management: A Review of State Medicaid PCCM Programs. Center for Health Care Strategies; 2000. Available at: http://www.chcs.org/publications/purchasing.html

Sofaer S. Qualitative Methods: What Are They and Why Use Them? Health Services Research 1999;34(5; Part II):1101-18.

South Carolina Department of Health and Environmental Control. Evaluation Resources. Available at: http://www.scdhec.net/HS/epi/Centered/resources.htm

Stone E, Bailit M, Greenberg M et al., Comprehensive Health Data Systems Spanning the Public-Private Divide: The Massachusetts Experience. American Journal of Preventive Medicine 1998;14(3S):40-5.

Thorpe KE, Florence CS, Gray B. Market Incentives, Plan Choices, and Price Increases. Health Affairs 1999;19(1):194-202.

Uhrig JD. Beneficiaries' Use of Quality Reports for Choosing Medicare Health Plans. [Ph.D. Dissertation]. The Pennsylvania State University; 2001.

U.S. General Accounting Office. Health Insurance: Management Strategies Used by Large Employers to Control Costs. GAO/HEHS-97-71. Washington, DC: U.S. Government Printing Office; 1997.

Wennberg JE, Gittelsohn A. Small Area Variations in Health Care Delivery. Science 1973, 82(117): 1102-1108.

Yeaton W, Camberg L. Program Evaluation for Managers. Boston, MA: Management Decision and Research Center, Health Services Research and Development Services, Office of Research and Development, Department of Veterans Affairs; 1997.

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AHRQ Publication No. 02-0029

Current as of May 2002
Internet Citation: Evaluating the Impact of Value-Based Purchasing: A Guide for Purchaser: A Guide for Purchasers. May 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/value/valuebased/evalvbp6.html