Dimensions of consumer-assessed quality of Medicare managed-care health plans

OBJECTIVES. We investigated relationships at the health-plan level among me mber ratings of and reports on plans in the Consumer Assessment of Health P lans Survey (CAHPS). We sought a more parsimonious description of the repor ts that can be used in analyses of die distribution and correlates of consu mer-assessed quality. SUBJECTS. There were 89,419 Medicare beneficiaries enrolled in 212 Medicare managed-care health plans who responded to CAHPS in 1998. MEASURES. There were 39 survey items measuring consumer ratings of and repo rts on care. METHODS. We adjusted correlations for sampling variability in the plan means and performed a principal factor analysis of the report item s with oblique rotation. We grouped items that loaded heavily on the differ ent factors, formed composites, and regressed rating items on the report co mposites. RESULTS. Pour factors explained 75% of the variance in the reports. The cor responding groups of items were concerned with the following subjects: (1) interactions around delivery of care in the doctor's office; (2) customer s ervice from the plan; (3) access to medical services provided by the plan, such as specialist care, equipment, therapy, or drugs; and (4) advice on he alth-promoting activities. Corrected Cronbach a: for composites were 0.97, 0.93, 0.86, and 0.66. The "delivery" composite was strongly predictive of o verall ratings elf: care, doctor, and specialist; the "customer" composite was strongly predictive of overall ratings of the plan, CONCLUSIONS. CAHPS distinguishes among dimensions of between-plan variabili ty of consumer-assessed quality. Different global ratings are related. to d istinct groups of consumer reports an their experiences.