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Health Plans' Use of Physician Resource Use and Quality Measures

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Publication Date: October 2007

Publisher(s): Mathematica Policy Research, Inc.

Author(s): Stephanie Peterson; Margaret Colby; Timothy Lake

Funder(s): Medicare Payment Advisory Commission (U.S.)

Funder(s): Medicare Payment Advisory Commission (U.S.)

Topic: Health (Health care planning)

Keywords: Episode Grouper; Physician Resource; Health Plans

Type: Report


In recent years, health plans have developed measures of health service resource use to assess efficiency of care physicians and other providers deliver primarily relying on tools commonly known as "episode groupers." This report investigates the use of episode grouper-based measures in the private sector in four health markets around the country: Austin, Boston, Cleveland, and Seattle. Health plans included in the study have multiple years of technical experience implementing physician resource use and quality measures; however, most are still in the early stages of determining the best ways to use these measures in their local markets. The report includes lessons for future quality measurement efforts in Medicare and other programs.