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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2016 State of Wisconsin Group Health Insurance Program
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Wisconsin Department Of Employee Trust Funds It's Your Choice 2016


Local Health Plan
Insurance for Employees
and Retirees
(PO6)


2015 Health Plan Report Card

Overuse of Services Ratings

The “Overuse of Services Ratings” in the table below looks at how well a plan does uses services wisely.  In other words, we look at avoiding using services when they are not needed.

Providing services that are not necessary can be harmful to your health.  For example, unneeded antibiotics can put you at greater risk of infections.  A CT scan exposes you to 400 times the radiation of an x ray or more.  Also, overuse simply means health care dollars are spent unwisely.

The measures that make up the rating look at:

  • Overuse of imaging: CT scans, MRIs and x rays
  • Not using antibiotics appropriately in regard to:
    • Children with upper respiratory infections
    • Children with pharyngitis
    • Adults with bronchitis

More stars mean more appropriate use.  In other words, less overuse of services.  Less stars mean more overuse of services.

Overuse of Services

Health Plan Star Rating
Anthem Blue (all plans)1 22
Arise Health Plan (all plans)2 33
Dean Health Insurance (all plans)3 44
Group Health Cooperative of Eau Claire 33
GHC of South Central Wisconsin 55
Gundersen Health Plan 33
Health Tradition Health Plan 33
HealthPartners Health Plan 55
Humana (all plans)4 11
Medical Associates Health Plans 22
MercyCare Health Plans 44
Network Health5 33
Physicians Plus  44
Security Health Plan 22
UnitedHealthcare of Wisconsin 11
Unity (all plans)6 33
WEA Trust (all plans)7 33

TABLE KEY

Sort columns by clicking on the header.

5

Highest rating

4

 

3

 

2

 

1

lowest rating

RESOURCES

List of MeasuresList of measures that make up ratings and the health plans’ results in each.

Meathods UsedReview our methods used for developing these ratings.

Quality resource linksOther Quality Resource links for ratings.

List of MeasuresHealth Plan Features and links to plan description pages.

notes:

For the list of the measures that make up the rating above and to see the health plans’ results in each measure, click here.

1.2016 ETF participating Anthem plans include Northeast and Southeast
2.2016 ETF participating Arise plans include Arise Health Plan and Arise Health Plan - Aspirus Arise
3.2016 ETF participating Dean plans include Dean Health Insurance and Dean Prevea360
4.2016 ETF participating Humana plans include Eastern and Western
5.2016 ETF participating Network Health plans include Northeast and Southeast.
6.2016 ETF participating Unity plans include Unity-Community and Unity-UW Health
7.2016 ETF participating WEA Trust plans include East, South Central, Northwest Chippewa Valley and Northwest Mayo Clinic Health System

Note: ETF participating WPS plans include the IYC Access Plans, SMP and IYC Medicare Plus.

Disclaimer:
Every effort has been made to ensure that this information is accurate, but may be subject to change. Please note revision dates located at the bottom of each page. In the event of conflicting information, federal law, state statute, state health contracts and/or policies and provisions established by the State of Wisconsin Group Insurance Board shall be followed.

This page was last modified on: 9/28/2015 12:50:07 PM