Cost-Benefit Analysis of a New HEDIS Performance Measure for Pneumococcal Vaccination

Abstract

Objectives Measurement of the quality of care provided by managed care organizations (MCOs) has achieved national prominence, though there is controversy regarding its value. This article assesses the economic implications of a new Health Plan Employer Data and Information Set (HEDIS®) measure for pneumococcal vaccination. Methods A Markov decision model, with Monte Carlo simulations, was utilized to conduct a cost-benefit analysis of annual HEDIS-associated interventions, which were repeated for 5 consecutive years, in an average Medicare MCO, using a societal perspective and a 3% annual discount rate. Results Compared with the status quo, the HEDIS intervention will be cost saving 99.8% of the time, with an average net savings of $3.80 per enrollee (95% probability interval: $0.73–$6.87). Conclusions The new HEDIS measure will save societal dollars. This type of analysis is essential if performance measurement is to become a legitimate part of our health care landscape.