Measures of Health Plan Quality

To Get: HEDIS® measures

Do This:

• Purchase results from the National Committee for Quality Assurance (NCQA).
• Ask plans to report their HEDIS® measures directly to you.

To Get: Measures of members' experience and satisfaction

Do This:

• Conduct a survey of your audience. The CAHPS® survey is a standardized tool for doing this. To get comparative data, you may want to participate in the National CAHPS® Benchmarking Database (NCBD). Even if you don't participate, you can get national benchmarks and averages from the NCBD's annual report.

OR

• If your plans report HEDIS®, ask NCQA or the plans themselves for the results of their CAHPS® surveys. HEDIS® includes an expanded version of the CAHPS® survey.

OR

• Conduct a survey of patients with chronic conditions, in order to assess the quality of chronic care. The FACCT|ONE survey can help you gather this kind of information.

To Get: Other information, such as disenrollment rates and grievances

Do This:

• Ask your State's insurance commissioner for information such as complaint or grievance rates, licensure data, and financial information, which can tell you something about the stability of the plan.

OR

• Ask the Centers for Medicare & Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA), for quality information (including HEDIS® results) for the health plans serving Medicare beneficiaries (Go to CMS's data at http://www.medicare.gov).
• Request the information directly from the plans from which you purchase services, possibly as a stipulation in the contract.

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