Date of Conferral

2021

Degree

Ph.D.

School

Public Health

Advisor

Egondu R. Onyejekwe

Abstract

In the interest of improving patient outcomes, significant investments in operationalized quality of care within the Medicare space have promulgated a low-resolution narrative predicated on conflation of higher quality scores with improved population health. Concomitant financial incentivization of Medicare Advantage plans through aligned Star Measures places contracts as the fundamental unit of most care quality analyses, but no studies have considered how present incentivization schema have impacted physician use and associated quality scores over time for breast cancer screening (BCS), colorectal cancer screening (CCS), and annual flu vaccination (AFV) at a county level. Guided by the Evidence Based Model framework, this quantitative cross-sectional secondary data study used simple linear regression, Spearman Correlation, and Mann Kendall Trend tests to analyze public Medicare quality and physician claims data. Results showed that AFV utilization correlated with aligned quality scores for U.S. counties between 2012 and 2017, but no such association was found to exist for CCS or BCS. County-level physician use slightly increased over this period for BCS and AFV, but a small monotonic decline was observed for CCS. Year-over-year changes in quality scores did not correlate with changes in physician use of each preventive service. Study findings indicated that incentivized quality measures aimed at health plan performance are insufficient to produce measurable population-level impacts in the utilization of preventive services in the Medicare space. This study contributes to positive social change by highlighting that health plans can demonstrate improvements in incentivized quality measure performance without improving physician utilization at the aggregated county level.

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