Each year the Department of Employee Trust Funds evaluates participating health plans on care delivery in areas such as 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 that most impact our members, such as hypertension and diabetes, and compliment the care initiatives we have with our health plans, like care coordination.
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.
You can use the ratings in the Health Plan Report Card to help you decide 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.
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 composite ratings to assess how well the health plans are doing, based on these national measures. In addition, we have included ETF member grievance rates as their own stand-alone rating. 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 select measures from the “Quality,” “Care Coordination” and “Overuse of Services” composite measures 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 can mean health care dollars are spent unwisely. The measures in Overuse of Services capture how well health plans provide appropriate limits on care that don't add value.
- 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.