State of Wisconsin
It's Your Choice 2017
Group Health Insurance Program
(State Employees, Retirees, Continuants and Graduate Assistants)
2016 Health Plan Report Card
Each year the Department of Employee Trust Funds evaluates participating health plans on care delivery in areas such as wellness, prevention, disease management, efficient use of resources and what surveyed members have said about the quality of their plan. The measures selected for health plan evaluation represent the conditions and diseases of our members, such as hypertension and diabetes, and compliment the care initiatives we have with our health plans, like care coordination. There are several organizations that also provide useful information about health care quality. We
encourage you to look into the other quality information resources.
What do we know about how well health plans are doing?
How well your health plan performs can affect your health. The better your health plan does, the better off you are.
So we recommend looking at the ratings here before deciding on a health plan. Use this along with other information to make an informed decision when picking a health plan.
Health plan performance varies
We see much variation among the health plans in the measures we use. Also, no health plan is a top or bottom performer in every area. They do better in one thing and worse in another.
So look closely at how they are doing, especially in the types of care that are most important to you.
Performance can be measured
The ability to measure things like quality, care coordination and overuse of services improves every year. We use nationally recognized measures from federal agencies and a national health plan accrediting body.
We have created four ratings to assess how well the health plans are doing, based on these national measures. In addition, we have included ETF member grievance rates. In all, these five ratings can help you make an informed decision when choosing a health plan.
These five ratings are:
- Overall Performance: This is the high level picture of how well a plan is doing. The index uses significant measures of “Quality”, “Care Coordination” and “Overuse of Services” to give you a well-rounded snapshot.
- Quality: This looks at how well a plan does helping people with their health, such as keeping blood pressure in check and keeping your preventive screenings up to date. This also includes survey results of what people think about their plan and doctor.
- Care Coordination: It is important to manage care over time and at important “hand-offs”, like hospital discharge to home. The measures that make up Care Coordination rate plans on things like avoiding readmission to the hospital and managing medications over time.
- Overuse of Services: Providing services that are not necessary can be harmful to your health. For example, unneeded antibiotics can put you at greater risk of infections. Also, overuse simply means health care dollars are spent unwisely.
- Grievances: This is the rate of grievances that ETF members have made to their health plan. You may see lower rates as more desirable when selecting a health plan.
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: 9/26/2016 2:19:25 PM