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Wisconsin Department of Employee Trust Funds header image It's Your Choice 2018 State of Wisconsin Group Health Insurance Program
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2018 It's Your Choice - State of Wisconsin Group Health Insurance for Employees and Retirees

Wisconsin Department Of Employee Trust FundsIt's Your Choice 2018


State of Wisconsin
Group Health Insurance Program
(State Employees, Retirees, Continuants and Graduate Assistants)

2017 Health Plan Report Card

Quality Measures

The following are the measures that make up the four composite ratings. Grievances is a stand-alone measure that is solely based on the number of grievances received.

You can click on the measure name to see how health plans perform in that measure.

Overall Performance composite

  1. Controlling High Blood Pressure (CBP)
  2. Comprehensive Diabetes Care: Blood Pressure Control (CDC)
  3. Plan All-Cause Readmissions (PCR)
  4. Antidepressant Medication Management (AMM)
  5. Medication Management for People with Asthma (MMA)
  6. Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB)
  7. Health Plan Rating (survey question #42)
  8. Care Coordination (survey question #22)
  9. Appropriate Testing for Children with Pharyngitis (CWP)

 

Quality composite

  1. Controlling High Blood Pressure (CBP)
  2. Comprehensive Diabetes Care (CDC):
  3. Breast Cancer Screening (BCS)
  4. Colorectal Cancer Screening (COL)
  5. Health Plan Rating (survey question #42)
  6. Primary Care Physician Rating (survey question #23)
  7. Specialty Care Physician Rating (survey question #27)

 

Care Coordination composite

  1. Ambulatory Care: Emergency Department Visits (AMB)
  2. Plan All-Cause Readmissions (PCR)
  3. Follow-Up After Hospitalization for Mental Illness (FUH)
  4. Antidepressant Medication Management (AMM)
  5. Follow-Up Care for Children Prescribed ADHD Medication (ADD)
  6. Medication Management for People with Asthma (MMA)
  7. Care Coordination (survey question #22)

 

Overuse of Services composite

  1. Appropriate Treatment for Children with Upper Respiratory Infection (URI)
  2. Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB)
  3. Use of Imaging Studies for Low Back Pain (LBP)
  4. Appropriate Testing for Children with Pharyngitis (CWP)

 

- The measures that come from a survey of health plan members say “survey question” after the name along with the question number

- Measures with three letters after the name are based on data from the health plan

- For more information on the measures and how they are used in the rankings, see Methodology.

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB)

Measure description: 
This is the rate of health plan members with acute bronchitis who did not receive an antibiotic prescription.  Such prescriptions to treat people with bronchitis should be avoided.

A higher figure means better performance.

Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (AAB)**

Health Plan Rate
Dean Health Insurance (all plans)1 33.61%
GHC of Eau Claire 35.42%
GHC of South Central Wisconsin  68.21%
Gundersen Health Plan 44.37%
HealthPartners Health Plan 39.94%
Medical Associates Health Plans 21.66%
MercyCare Health Plans 19.05%
Network Health 20.87%
Physicians Plus  46.74%
Quartz (all plans)2 40.06%
Security Health Plan (all plans)3 33.10%
Unity Health Insurance (all plans)4 38.34%
WEA Trust (all plans)5 26.38%

TABLE KEY

Sort columns by clicking on the header.

 

A higher figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

Follow-Up Care for Children Prescribed ADHD Medication (ADD)

Measure description: 
The measure is in regard to children prescribed attention-deficit/hyperactivity disorder (ADHD) medication.  For these children, the measure is the rate who stayed on ADHD medications at least seven months and also had follow up visits.

A higher figure means better performance.

Follow-Up Care for Children Prescribed ADHD Medication (ADD)**

Health Plan Rate
Dean Health Insurance (all plans)1 37.08%
GHC of Eau Claire NA
GHC of South Central Wisconsin  70.27%
Gundersen Health Plan NA
HealthPartners Health Plan 48.00%
Medical Associates Health Plans NA
MercyCare Health Plans NA
Network Health 40.54%
Physicians Plus  43.33%
Quartz (all plans)2 49.93%
Security Health Plan (all plans)3 30.95%
Unity Health Insurance (all plans)4 51.24%
WEA Trust (all plans)5 46.51%

TABLE KEY

Sort columns by clicking on the header.

 

A higher figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

Ambulatory Care: Emergency Department Visits (AMB)

Measure description: 
This is a measure of members using the Emergency Department.  The rates in the table are emergency department visits per 1,000 member years.

A lower figure means better performance.

Ambulatory Care: Emergency Department Visits (AMB)**

Health Plan Rate
Dean Health Insurance (all plans)1 221.51
GHC of Eau Claire 154.36
GHC of South Central Wisconsin  138.66
Gundersen Health Plan 257.01
HealthPartners Health Plan 142.14
Medical Associates Health Plans 176.32
MercyCare Health Plans 244.24
Network Health 157.27
Physicians Plus  196.34
Quartz (all plans)2 216.77
Security Health Plan (all plans)3 166.38
Unity Health Insurance (all plans)4 217.08
WEA Trust (all plans)5 183.41

TABLE KEY

Sort columns by clicking on the header.

 

A lower figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

Antidepressant Medication Management (AMM)

Measure description: 
This is the rate of health plan members with major depression taking antidepressants who stayed on the medication for at least six months.

A higher figure means better performance.

Antidepressant Medication Management (AMM)**

Health Plan Rate
Dean Health Insurance (all plans)1 59.05%
GHC of Eau Claire 63.64%
GHC of South Central Wisconsin  61.87%
Gundersen Health Plan 56.99%
HealthPartners Health Plan 59.77%
Medical Associates Health Plans 48.17%
MercyCare Health Plans 58.25%
Network Health 60.44%
Physicians Plus  62.08%
Quartz (all plans)2 56.10%
Security Health Plan (all plans)3 57.61%
Unity Health Insurance (all plans)4 54.83%
WEA Trust (all plans)5 59.05%

TABLE KEY

Sort columns by clicking on the header.

 

A higher figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

Breast Cancer Screening (BCS)

Measure description: 
This is the rate of health plan members who are women age 50 - 74 that had a mammogram to screen for breast cancer.

A higher figure means better performance.

Breast Cancer Screening
(BCS)**

Health Plan Rate
Dean Health Insurance (all plans)1 78.48%
GHC of Eau Claire 87.63%
GHC of South Central Wisconsin  77.11%
Gundersen Health Plan 83.16%
HealthPartners Health Plan 79.43%
Medical Associates Health Plans 80.68%
MercyCare Health Plans 77.06%
Network Health 75.60%
Physicians Plus  79.94%
Quartz (all plans)2 81.47%
Security Health Plan (all plans)3 85.41%
Unity Health Insurance (all plans)4 81.62%
WEA Trust (all plans)5 82.70%

TABLE KEY

Sort columns by clicking on the header.

 

A higher figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

Controlling High Blood Pressure (CBP)

Measure description: 
This is the rate of health plan members with hypertension that have their blood pressure in control (<140/90) in the prior year.

A higher figure means better performance.

Controlling High Blood Pressure (CBP)**

Health Plan Rate
Dean Health Insurance (all plans)1 87.04%
GHC of Eau Claire 49.08%
GHC of South Central Wisconsin  75.18%
Gundersen Health Plan 77.37%
HealthPartners Health Plan 74.31%
Medical Associates Health Plans 78.35%
MercyCare Health Plans 76.11%
Network Health 77.87%
Physicians Plus  NR
Quartz (all plans)2 63.82%
Security Health Plan (all plans)3 80.05%
Unity Health Insurance (all plans)4 75.18%
WEA Trust (all plans)5 66.67%

TABLE KEY

Sort columns by clicking on the header.

 

A higher figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

Comprehensive Diabetes Care: Blood Pressure Control (CDC)

Measure description: 
This is the rate of health plan members with diabetes that have their blood pressure in control (< 140/90) in the prior year.

A higher figure means better performance.

Comprehensive Diabetes Care: Blood Pressure Control (CDC)**

Health Plan Rate
Dean Health Insurance (all plans)1 83.84%
GHC of Eau Claire 66.06%
GHC of South Central Wisconsin  81.57%
Gundersen Health Plan 80.66%
HealthPartners Health Plan 79.56%
Medical Associates Health Plans 83.58%
MercyCare Health Plans 74.50%
Network Health 82.85%
Physicians Plus  NR
Quartz (all plans)2 68.57%
Security Health Plan (all plans)3 83.03%
Unity Health Insurance (all plans)4 81.00%
WEA Trust (all plans)5 71.05%

TABLE KEY

Sort columns by clicking on the header.

 

A higher figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

Comprehensive Diabetes Care (CDC): Blood Sugar Control

Measure description: 
This is the rate of health plan members with diabetes that have their blood sugar in control (HbA1c < 8%) in the prior year.

A higher figure means better performance.

Comprehensive Diabetes Care (CDC): Blood Sugar Control**

Health Plan Rate
Dean Health Insurance (all plans)1 64.33%
GHC of Eau Claire 54.13%
GHC of South Central Wisconsin  61.13%
Gundersen Health Plan 66.79%
HealthPartners Health Plan 63.87%
Medical Associates Health Plans 67.15%
MercyCare Health Plans 63.05%
Network Health 70.99%
Physicians Plus  NR
Quartz (all plans)2 55.69%
Security Health Plan (all plans)3 73.91%
Unity Health Insurance (all plans)4 65.67%
WEA Trust (all plans)5 59.61%

TABLE KEY

Sort columns by clicking on the header.

 

A higher figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

Colorectal Cancer Screening (COL)

Measure description: 
This is the rate of health plan members 50 - 75 years old that had one of several types of appropriate screens for colorectal cancer.

A higher figure means better performance.

Colorectal Cancer Screening (COL)**

Health Plan Rate
Dean Health Insurance (all plans)1 72.15%
GHC of Eau Claire 72.99%
GHC of South Central Wisconsin  77.62%
Gundersen Health Plan 72.51%
HealthPartners Health Plan 69.21%
Medical Associates Health Plans 66.42%
MercyCare Health Plans 66.45%
Network Health 74.09%
Physicians Plus  NR
Quartz (all plans)2 68.00%
Security Health Plan (all plans)3 74.70%
Unity Health Insurance (all plans)4 81.02%
WEA Trust (all plans)5 69.67%

TABLE KEY

Sort columns by clicking on the header.

 

A higher figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

Appropriate Testing for Children with Pharyngitis (CWP)

Measure description:
This is the rate of children with pharyngitis who received a strep test before receiving an antibiotic prescription.  Such prescriptions should only happen if a strep test occurred.

A higher figure means better performance.

Appropriate Testing for Children with Pharyngitis (CWP)**

Health Plan Rate
Dean Health Insurance (all plans)1 85.96%
GHC of Eau Claire 91.18%
GHC of South Central Wisconsin  93.26%
Gundersen Health Plan 92.31%
HealthPartners Health Plan 94.45%
Medical Associates Health Plans 81.99%
MercyCare Health Plans 80.53%
Network Health 77.40%
Physicians Plus  90.38%
Quartz (all plans)2 88.28%
Security Health Plan (all plans)3 87.42%
Unity Health Insurance (all plans)4 87.49%
WEA Trust (all plans)5 84.89%

TABLE KEY

Sort columns by clicking on the header.

 

A higher figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

Follow Up After Hospitalization for Mental Illness (FUH)

Measure description: 
This measure is in regard to health plan members over age five hospitalized for treatment of certain types of mental illness.  The rate reported is for those who had a follow up appointment with a mental health professional within a week after being discharged from the hospital.

A higher figure means better performance.

Follow Up After Hospitalization for Mental Illness (FUH)**

Health Plan Rate
Dean Health Insurance (all plans)1 58.15%
GHC of Eau Claire NA
GHC of South Central Wisconsin  75.00%
Gundersen Health Plan 33.33%
HealthPartners Health Plan 60.62%
Medical Associates Health Plans 56.25%
MercyCare Health Plans 62.50%
Network Health 50.00%
Physicians Plus  66.67%
Quartz (all plans)2 66.14%
Security Health Plan (all plans)3 61.26%
Unity Health Insurance (all plans)4 69.08%
WEA Trust (all plans)5 59.74%

TABLE KEY

Sort columns by clicking on the header.

 

A higher figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

Use of Imaging Studies for Low Back Pain (LBP)

Measure description:
This is the rate of health plan members who did not have an X-ray, MRI or CT scan within four weeks of a complaint of low back pain. 

A higher figure means better performance.

Use of Imaging Studies for Low Back Pain (LBP)**

Health Plan Rate
Dean Health Insurance (all plans)1 81.95%
GHC of Eau Claire 83.85%
GHC of South Central Wisconsin  89.37%
Gundersen Health Plan 85.89%
HealthPartners Health Plan 82.98%
Medical Associates Health Plans 79.58%
MercyCare Health Plans 79.91%
Network Health 82.38%
Physicians Plus  75.43%
Quartz (all plans)2 78.19%
Security Health Plan (all plans)3 72.78%
Unity Health Insurance (all plans)4 78.02%
WEA Trust (all plans)5 84.55%

TABLE KEY

Sort columns by clicking on the header.

 

A higher figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

Medication Management for People with Asthma (MMA)

Measure description: 
This is the rate of health plan members with persistent asthma age 5 to 64 who stayed on their controller medication for at least 75% of the treatment period.

A higher figure means better performance.

Medication Management for People with Asthma (MMA)**

Health Plan Rate
Dean Health Insurance (all plans)1 59.34%
GHC of Eau Claire 50.91%
GHC of South Central Wisconsin  47.77%
Gundersen Health Plan 54.04%
HealthPartners Health Plan 54.20%
Medical Associates Health Plans 38.58%
MercyCare Health Plans 59.84%
Network Health 51.82%
Physicians Plus  55.65%
Quartz (all plans)2 50.23%
Security Health Plan (all plans)3 51.19%
Unity Health Insurance (all plans)4 48.80%
WEA Trust (all plans)5 52.01%

TABLE KEY

Sort columns by clicking on the header.

 

A higher figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

Plan All-Cause Readmissions (PCR)

Measure description: 
This is a measure of members being readmitted back to a hospital within 30 days of being discharged from a hospitalization. 

The measure results in the table below are risk adjusted rates.  A lower figure means better performance.

Plan All-Cause Readmissions (PCR)**

Health Plan Rate
Dean Health Insurance (all plans)1 0.7219
GHC of Eau Claire 0.8012
GHC of South Central Wisconsin  0.7434
Gundersen Health Plan 0.7518
HealthPartners Health Plan 0.8734
Medical Associates Health Plans 0.6916
MercyCare Health Plans 1.0239
Network Health 0.5505
Physicians Plus  0.5826
Quartz (all plans)2 0.7439
Security Health Plan (all plans)3 0.7658
Unity Health Insurance (all plans)4 0.7751
WEA Trust (all plans)5 0.6124

TABLE KEY

Sort columns by clicking on the header.

 

A lower figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

Appropriate Treatment for Children with Upper Respiratory Infection (URI)

Measure description:
This is the rate of children with upper respiratory infection who were not given an antibiotic prescription. 

A higher figure means better performance.

Appropriate Treatment for Children with Upper Respiratory Infection (URI)**

Health Plan Rate
Dean Health Insurance (all plans)1 93.36%
GHC of Eau Claire 85.71%
GHC of South Central Wisconsin  96.73%
Gundersen Health Plan 89.04%
HealthPartners Health Plan 90.35%
Medical Associates Health Plans 73.71%
MercyCare Health Plans 85.79%
Network Health 87.60%
Physicians Plus  94.89%
Quartz (all plans)2 92.43%
Security Health Plan (all plans)3 86.12%
Unity Health Insurance (all plans)4 92.26%
WEA Trust (all plans)5 90.55%

TABLE KEY

Sort columns by clicking on the header.

 

A higher figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

Care Coordination (survey question #22)

Measure description: 
In a survey, adult health plan members were asked:  “In the last 12 months, how often did your personal doctor seem informed and up-to-date about the care you got from these doctors or other health providers?”

The response options were “never”, “sometimes”, “usually” and “always”.  The result reported is the rate of people that said “always”.

A higher figure means better performance.

Care Coordination
(survey question #22)*

Health Plan Rate
Dean Health Insurance (all plans)1 57.20%
GHC of Eau Claire 51.87%
GHC of South Central Wisconsin  52.56%
Gundersen Health Plan 60.39%
HealthPartners Health Plan 54.14%
Medical Associates Health Plans 47.13%
MercyCare Health Plans 51.12%
Network Health 51.43%
Physicians Plus  50.00%
Quartz (all plans)2 56.92%
Security Health Plan (all plans)3 54.86%
Unity Health Insurance (all plans)4 57.97%
WEA Trust (all plans)5 55.33%

TABLE KEY

Sort columns by clicking on the header.

 

A higher figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

Primary Care Physician Rating (survey question #23)

Measure description: 
In a survey, adult health plan members were asked:  “Using any number from 0 to 10, where 0 is the worst personal doctor possible and 10 is the best personal doctor possible, what number would you use to rate your personal doctor?”

The result reported is the rate of people that responded with a “9” or “10”.

A higher figure means better performance.

Primary Care Physician Rating
(survey question #23)*

Health Plan Rate
Dean Health Insurance (all plans)1 76.46%
GHC of Eau Claire 69.30%
GHC of South Central Wisconsin  67.80%
Gundersen Health Plan 76.14%
HealthPartners Health Plan 67.86%
Medical Associates Health Plans 72.68%
MercyCare Health Plans 70.45%
Network Health 64.19%
Physicians Plus  66.92%
Quartz (all plans)2 61.91%
Security Health Plan (all plans)3 70.59%
Unity Health Insurance (all plans)4 59.60%
WEA Trust (all plans)5 72.65%

TABLE KEY

Sort columns by clicking on the header.

 

A higher figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

Specialty Care Physician Rating (survey question #27)

Measure description: 
In a survey, adult health plan members were asked:  “We want to know your rating of the specialist you saw most often in the last 12 months. Using any number from 0 to 10, where 0 is the worst specialist possible and 10 is the best specialist possible, what number would you use to rate that specialist?”

The result reported is the rate of people that responded with a “9” or “10”.

A higher figure means better performance.

Specialty Care Physician Rating
(survey question #27)*

Health Plan Rate
Dean Health Insurance (all plans)1 67.20%
GHC of Eau Claire 62.56%
GHC of South Central Wisconsin  64.47%
Gundersen Health Plan 70.20%
HealthPartners Health Plan 65.22%
Medical Associates Health Plans 65.55%
MercyCare Health Plans 68.18%
Network Health 67.72%
Physicians Plus  71.83%
Quartz (all plans)2 69.74%
Security Health Plan (all plans)3 65.33%
Unity Health Insurance (all plans)4 69.28%
WEA Trust (all plans)5 62.90%

TABLE KEY

Sort columns by clicking on the header.

 

A higher figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

Health Plan Rating (survey question #42)

Measure description: 
In a survey, adult health plan members were asked:  “Using any number from 0 to 10, where 0 is the worst health plan possible and 10 is the best health plan possible, what number would you use to rate your health plan?“.

The result reported is the rate of people that responded with a “9” or “10”.

A higher figure means better performance.

Health Plan Rating
(survey question #42)*

Health Plan Rate
Dean Health Insurance (all plans)1 43.10%
GHC of Eau Claire 41.59%
GHC of South Central Wisconsin  49.24%
Gundersen Health Plan 38.35%
HealthPartners Health Plan 40.59%
Medical Associates Health Plans 41.30%
MercyCare Health Plans 33.63%
Network Health 35.73%
Physicians Plus  41.38%
Quartz (all plans)2 44.39%
Security Health Plan (all plans)3 32.58%
Unity Health Insurance (all plans)4 45.55%
WEA Trust (all plans)5 46.25%

TABLE KEY

Sort columns by clicking on the header.

 

A higher figure means
better performance.

 

RESOURCES

Meathods UsedReview our methods used for developing these ratings.

List of MeasuresAvailable Health Plans and links to plan description pages.

notes:

*The CAHPS Health Plan Survey is a program of the U.S. Agency for Healthcare Research and Quality (AHRQ).
**This is a HEDIS® measure from the National Committee for Quality Assurance (NCQA).
“NA”: Not Applicable  -  The health plan followed the specifications but the denominator was too small to report a valid rate.
"NR": Not Reported - The health plan did not report the measure.
1.Participating Dean plans include Dean Health Insurance and Dean Prevea360.
2.Participating Quartz plans include Community and UW Health. Result is the average of Gundersen, Physicians Plus and Unity ratings that is weighted based on the number of ETF members enrolled in each plan for 2016.
3.Participating Security Health plans include Central and Valley.
4.Participating Unity Health Insurance plans include Community and UW Health.
5.Participating WEA Trust plans include East, Northwest Chippewa Valley, Northwest Mayo Clinic Health System, IYC Access Health Plan, State Maintenance Plan 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: 9/11/2017 6:03:21 PM