Case-mix adjustment

Medicare CAHPS Case-Mix Adjustment Processes

The CAHPS measures are case-mix adjusted to take into account the mix of enrollees. It includes dual eligibility and education among other variables. The table below includes the case-mix variables and shows the case-mix coefficients for each of the CAHPS measures included in the Medicare Plan Finder tool.  The coefficients indicate how much higher or lower people with a given characteristic tend to respond compared to others with the baseline value for that characteristic, on the 0-100 scale used in consumer reports.  For example, for the measure "rating of care", the coefficient for "age 80-84"  is +1.00, indicating that respondents in that age range tends to score their plans 1.00 point higher than otherwise similar people in the 70-74 age range, the baseline or reference category.  Similarly dual eligibles tend to respond -0.46 points lower on this item than otherwise similar non-duals.  Contracts with more-than-average concentrations of respondents who are in the 80-84 age range will be adjusted downwards to compensate for the positive response tendency of their respondents.  Similarly, contracts with above-average concentrations of respondents who are dual eligibles will be adjusted upwards to compensate for their respondents negative response tendency. The case-mix patterns are not always consistent across measures.

 

The composites consist of multiple items, each of which is adjusted separately before combining the adjusted scores into a composite score.  In the table we report the average of the coefficients for these several items, for each of the categories (rows) of the table, as a summary of the adjustment for the composite.

Health Plan CAHPS measures

	Rating of Plan	Rating of Care	Getting Care Quickly Composite	Getting Needed Care Composite	Doctors Who Communicate Well Composite	Health Plan Customer Service Composite
age: 64 and younger	-2.33	-1.72	-1.99	-2.34	0.22	-1.44
age: 65-69	-0.89	-0.70	-0.02	-0.47	0.13	0.17
age: 70-74(reference)	0.00	0.00	0.00	0.00	0.00	0.00
age: 75-79	1.19	0.14	0.00	0.39	-0.39	1.30
age: 80-84	2.32	1.00	0.21	0.82	-0.34	1.34
age: 85 and older	2.48	0.70	0.46	0.08	-0.89	1.10
less than an 8th grade education	1.07	-0.75	-1.94	-0.26	-0.48	-1.37
some high school	1.05	0.06	-0.97	0.40	0.23	-0.02
high school graduate(reference)	0.00	0.00	0.00	0.00	0.00	0.00
some college	-1.79	-1.09	-0.40	-1.57	-0.71	-1.79
college graduate	-3.02	-1.27	-0.32	-2.61	-0.86	-2.39
more than a bachelor's degree	-3.44	-2.01	-0.32	-3.12	-0.87	-3.29
general health rating_excellent	4.07	4.20	3.13	3.44	2.52	1.95
general health rating_very good	2.03	2.20	1.82	1.59	1.57	1.32
general health rating_good(reference)	0.00	0.00	0.00	0.00	0.00	0.00
general health rating_fair	-1.69	-2.44	-1.32	-1.87	-1.29	-1.11
general health rating_poor	-3.60	-3.98	-1.41	-3.11	-2.63	-2.69
mental health rating_excellent	3.41	4.69	3.70	4.81	4.33	2.33
mental health rating_very good	1.25	2.02	1.35	2.07	1.61	1.07
mental health rating_good(reference)	0.00	0.00	0.00	0.00	0.00	0.00
mental health rating_fair	-1.47	-1.67	-0.94	-1.71	-1.65	-1.18
mental health rating_poor	-3.35	-2.85	-1.39	-2.49	-1.39	-1.80
proxy_helped	-1.80	-2.08	-1.76	-1.16	-0.34	-1.34
proxy_answered	-1.94	-1.37	0.00	-0.47	-0.51	-1.48
Medicaid dual eligible	2.97	-0.46	-0.61	-0.91	-0.23	0.55
Low Income Subsidy(LIS)	0.75	-0.50	-1.21	-1.54	-0.28	-0.98

Prescription Drug CAHPS Measures

	Rate PD plan	Getting needed prescription drugs	Getting information from PD plan about prescription drugs
age: 64 and younger	-3.26	-2.66	-1.35
age: 65-69	-1.05	-0.36	0.65
age: 70-74(reference)	0.00	0.00	0.00
age: 75-79	1.62	0.16	0.06
age: 80-84	3.35	0.44	0.46
age: 85 and older	4.12	0.07	0.58
less than an 8th grade education	0.94	-2.35	-5.18
some high school	1.21	-0.80	-2.49
high school graduate(reference)	0.00	0.00	0.00
some college	-2.16	-1.01	-0.81
college graduate	-2.94	-1.25	-0.49
more than a bachelor's degree	-3.62	-2.20	-1.32
general health rating_excellent	4.50	1.08	4.18
general health rating_very good	2.12	1.15	2.66
general health rating_good(reference)	0.00	0.00	0.00
general health rating_fair	-1.58	-1.23	-1.39
general health rating_poor	-3.01	-2.75	-4.24
mental health rating_excellent	2.84	2.97	4.02
mental health rating_very good	1.16	1.52	2.04
mental health rating_good(reference)	0.00	0.00	0.00
mental health rating_fair	-1.21	-1.40	-1.99
mental health rating_poor	-3.50	-2.53	-1.77
proxy_helped	-3.29	0.40	1.35
proxy_answered	-2.87	1.55	1.75
Medicaid dual eligible	6.33	0.39	0.18
Low Income Subsidy(LIS)	5.31	-0.02	-2.04