Evaluating the relationship between health plan characteristics and CMS quality scores

The thesis uses multivariable linear regression to determine how different factors related to a health plan impact its ability to provide its members with high quality medical care and customer service as measured by the CMS, the federal government agency which administers the Medicare program. The thesis finds that past CMS scores positively affect current CMS scores, indicating that organizations can build competencies that improve CMS scores that carry forward to future periods. In addition, it finds a negative relationship between the size of the managed care market and CMS scores. The study finds a positive relationship between a plan’s level of focus on the Medicare Advantage business (percent of its members in the Medicare Advantage plans) and CMS scores. Finally, the study presents a case for expanding the usage of statistics and advanced analytics to help health plans evaluate their strategic options and make more well-informed strategic and operational decisions