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Performance Measures Based on the Mental Component Summary Score of the Veterans RAND 12-Item Health Survey Performed Better than Performance Measures Based on the Physical Component Summary in the Context of Differentiating Medicare Advantage Organizations

• For the five basic performance measures (PMs) applied to the entire Medicare Advantage Organization (MAO) samples, reliabilities for both physical component summary (PCS)– and mental component summary (MCS)–based PMs were low.

Modifying PM3 by Removing Sociodemographic Status Variables from the Risk-Adjustment Model Enhanced Intraclass Correlation Coefficients and Reliability

• The intraclass correlation coefficieint (ICC) and reliability of PM5 were enhanced by creating a threshold, based on quintiles of performance, by which lower- versus higher-performing MAOs could be compared.
• While the MCS-based PMs (PM3 and PM5) were improved, the reliability of the PCS-based PMs was not consistently improved to a meaningful degree by these modifications.
• Reliability was also improved by combining two or three cohorts, presumably because of the increased sample size. Combining the results across cohorts 13–15 gave a reliability of 0.67 for one of the modified MCS PMs. None of the PMs we examined achieved the usual threshold of 0.7 that is considered sufficient reliability for a PM, although some came close.

The Main Challenge to the Goals of This Project Is Related to the Characteristics of the Data

• The data reflect a nationally based system of care with considerable heterogeneity.
• An optimal database would include information to define individual providers or group practices within each of the MAOs.