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HEALTH PLAN REPORT CARD 2004



What is a health plan report card?
This health plan report card compares the quality of care delivered by health plans to their members, not just State of Ohio employees. To make an informed decision about your health plan, you should consider quality.

Where did this data come from?
The National Committee for Quality Assurance (NCQA) is an independent, non-profit organization that collects health plan quality data. NCQA uses this data to judge the performance of a health plan against its rigorous requirements. Successful completion of this evaluation process is called accreditation. This process is done on a county-by-county basis. Health Plan Report Card 2004 is based on NCQA data collected in 2002 and reported in 2003.

How should the grades and values on the report card be used?
In most cases the average grades for health plans that contract with the State of Ohio are the same or better than the national averages for plans accredited by NCQA. Consider enrolling in a plan which has scored high in those measures of most importance to you. The highest score possible is “A” while the lowest is “C-.” You will note that for Ohio Med scores are recorded only for “Customer Satisfaction” and “Quality Measures for Doctors”. This is because NCQA scored only select categories for PPOs during this period.

Grades are shown in the chart below for each health plan serving State of Ohio employees. The averages for these plans and the national averages for all HMOs accredited by NCQA also are shown.

Choosing the Right Health Plan: Suggestions for Completing Your Personal Worksheet
The health plan report card should be used together with materials you received from health plans and the Benefits Comparison Chart and Guide. You may wish to use the Personal Worksheet to assist you in selecting the plan best for you. Click here to download a copy of the Personal Worksheet. The document is available in Adobe Acrobat (PDF) format, and is 38KB in size. Complete each column of the worksheet with the information noted below.

Your Location
Indicate which health plans are available in the county where you live or work.

Your Benefits
Indicate the benefit information (e.g. emergency room, prescription pharmacy plan, therapies, etc.) that is most important to you and your family.

Your Doctors and Hospitals
Note if your preferred doctor and hospital are part of the health plan’s network.

Your Needs
Note any factors important to you and your family in choosing a health plan. Call health plans if you have specific needs. Some reasons you may want to call the health plans are:

  • To ask about availability of disease management programs or care for a specific chronic disease.
  • To find out about coverage for specific prescriptions.
  • To ask about coverage when you are outside the health plan’s service area for brief or extended periods of time.

Your Cost
Note the information that may affect your choice of health plan.

Quality Scores
Note the information that may affect your choice of health plan.

Your Choice
Using the information on your completed Personal Worksheet, decide which health plan is best for you and your family. If you are making a change, complete the enrollment process outlined in your Benefits Comparison Chart and Guide.

HMO - Health Maintenance Organization PPO - Preferred Provider Organization * For PPOs, NCQA only reports select data. ** This quality measure was reported by NCQA with “Customer satisfaction” scores which also are reported for PPOs.
DESCRIPTION OF MEASURES
Shown on the Report Card above are the composite grades earned by each health plan in various important areas. For many of the composite grades, the grades of the individual measures which make up the composite grade, are shown.

Customer Satisfaction Composite. One way to compare quality is to see if members are satisfied with the care and services they received from their health plans in the last 12 months. This measure looks at factors affecting customer satisfaction. Currently NCQA only measures select items for PPO plans such as Ohio Med. The composite grade is an average of all customer satisfaction measures. The measures are:

  • Claims Processing - This measure shows how often claims were handled in a reasonable time and if they were handled correctly.
  • Courteous and Helpful - Measures how pleasant the representatives were and the usefulness of the information provided.
  • Customer Service - This measure shows if written information was understandable and if customer service was helpful.
  • Getting Care Quickly - This measure shows how often a member received the help requested, if they were able to schedule regular and urgent appointments without difficulty and if they waited no more than 15 minutes past their appointment time.
  • Getting Needed Care - This measure shows how satisfied the member was with the primary care doctor and if referrals and approvals for needed care were arranged without difficulty.
  • Rating of All Health Care - This measure asks for the rating of the member’s total health care experience with the health plan.

Preventive Care for Adults Composite Grade. This measure shows if adult members have received services in a timely manner. Some of the measures for which high grades are desirable include:

  • Breast Cancer Screening - The goal of the Healthy People 2010, the national strategy for significantly improving the health of the nation over the coming decade, is for at least 60 percent of women age 52 to 64 to have at least one mammogram during the past two years.
  • Cervical Cancer Screening - The Healthy People goal is for at least 85 percent of women to have received at least one Pap smear during the previous three years.
  • Prenatal Care in First Trimester - The Healthy People goal is to have 90 percent of pregnant women receiving early prenatal care.
  • Checkups After Delivery - It estimates the percentage of women who had live births who had a checkup 21 to 56 days after delivery.

Preventive Care for Children Composite Grade. This measure shows if child members have received services in a timely manner. The items measured are well-child visits during each child’s 3rd through 6th years, adolescent immunizations, adolescent well-care visits and:

  • Childhood Immunization Status - The Healthy People goal is to have 90 percent of children up to two years of age fully immunized.
  • Well-Child Visits in the First 15 Months of Life - The Healthy People goal is to have at least 90 percent of all babies 18 months old and younger receive the care recommended by the American Academy of Pediatrics.

Comprehensive Diabetes Care Composite Grade. This measure shows if diabetic members have received services in a timely manner, including eye exams, HbA1c (Glycohemoglobin) tests, checks for poorly controlled HbA1c, kidney disease monitoring, lipid profile screenings and control of lipids.

Quality Measure for Doctors Composite Grade. This measure asks for the rating of the members’ personal doctors including how well the doctors communicate, rating of personal doctor, rating of specialists, percentage of PCPs who are board certified and:

  • Turnover Rate for Primary Care Physicians. A high score is desirable and is awarded to plans which have a low physician turnover rate. This measure indicates the chance that a doctor will stay with a plan over the long term. A low primary care physician turnover rate is an indicator of a health plan’s stability.

Heart-Related Care Composite Grade. This measure scores how well the plans manage heart-related care including cholesterol screening after an acute event, if cholesterol is controlled after an acute event and:

  • Beta Blocker Treatment After a Heart Attack. A high value for this measure is desirable. This measure estimates the number of members who were discharged from the hospital after a heart attack and were dispensed a prescription for beta blockers (if there were no contraindications). Beta blockers lower the blood pressure and reduce how hard the heart has to work.