Correlating Ratings of Health Insurance Plans to Their Providers' Attributes.

BACKGROUND: There is a push towards quality measures in health care. As a consequence, the National Committee for Quality Assurance (NCQA) has been publishing insurance plan quality measures.

OBJECTIVE: The objective of this study was to examine the relationship between insurance plan quality measures and the participating providers (doctors).

METHODS: We collected and analyzed provider and insurance plan data from several online sources, including provider directories, provider referrals and awards, patient reviewing sites, and hospital rankings. The relationships between the provider attributes and the insurance plan quality measures were examined.

RESULTS: Our analysis yielded several findings: (1) there is a moderate Pearson correlation (r=.376) between consumer satisfaction insurance plan scores and review ratings of the member providers, (2) referral frequency and provider awards are negligibly correlated to consumer satisfaction plan scores (correlations of r=.031 and r=.183, respectively), (3) there is weak positive correlation (r=.266) between the cost charged for the same procedures and consumer satisfaction plan scores, and (4) there is no significant correlation between member specialists' review ratings and specialty-specific insurance plan treatment scores for most specialties, except a surprising weak negative correlation for diabetes treatment (r=-.259).

CONCLUSIONS: Our findings may be used by consumers to make informed choices about their insurance plans or by insurances to understand the relationship between patients' satisfaction and their network of providers.