There are several measures of effective care for Healthcare Effectiveness Data and Information Set (HEDIS) measures. Of these measures, the Georgia Association of Health Plans and its member plans have selected the measures that are the best indicators of the quality of care for children, women and the diabetic population.
The measures selected provide the health plans with feedback on how members maintain good health, avoid illnesses, and manage chronic conditions such as diabetes.
| HEDIS MEASURES | Rates | ||||||
|---|---|---|---|---|---|---|---|
| Aetna - GA HMO/POS | BCBS - GA HMO/POS | Cigna - GA HMO/POS | Coventry - GA HMO/POS | Humana - GA HMO/POS | Kaiser - GA HMO | UHC - GA HMO/POS | |
| Breast Cancer Screening (Combined) | 67.00% | 69.30% | 66.20% | 66.88% | 63.32% | 78.70% | 66.70% |
| Cholesterol Management After Acute Events (Screening) | 85.00% | 87.72% | 91.33% | 82.94% | 78.57% | 90.70% | 87.18% |
| Childhood Immunization Status (Combo 2) | 88.00% | 89.05% | 86.58% | 81.54% | 75.59% | 93.20% | 85.34% |
| Prenatal & Postpartum Care (Postpartum Care) | 83.00% | 96.48% | 86.63% | 83.20% | 76.85% | 94.00% | 77.34% |
| Prenatal & Postpartum Care (Timeliness) | 95.00% | 87.11% | 97.09% | 94.50% | 91.48% | 98.00% | 91.27% |
| CAHPS - Member Satisfaction | Rates | ||||||
|---|---|---|---|---|---|---|---|
| Aetna - GA HMO/POS | BCBS - GA HMO/POS | Cigna - GA HMO/POS | Coventry - GA HMO/POS | Humana - GA HMO/POS | Kaiser - GA HMO | UHC - GA HMO/POS | |
| Rating of the Health Plan (rating of 8, 9, & 10) | 60.92% | 62.00% | 66.60% | 53.40% | 52.10% | 62.90% | 54.83% |
Breast cancer screening (mammography) is another important women’s health issue. It is estimated that approximately $8.1 billion is spent in the United States each year on treatment of breast cancer. In addition, it is also estimated that 178,480 women will be diagnosed with and 40,460 women will die of cancer of the breast in 2007.
Diabetes and cholesterol complications can lead to other chronic and possibly avoidable conditions, such as heart disease and renal failure.
Childhood Measures (childhood immunization, treatment of children with upper respiratory illness (URI), and testing of children with pharyngitis)
The rates/results from these measures are a clear indication of the quality of care being provided to children. They help the health plan determine if antibiotics are being appropriately used; whether or not children are being tested as needed for pharyngitis; and whether or not immunizations have been received.
Timeliness of prenatal and postnatal care is very important to women’s health. In addition, prenatal and postnatal care can also affect the health of the unborn child. The rates/results provide the health plans with meaningful data on the care mom and baby received prior to the delivery.
Rating of the health plan and claims processing was selected out of 9 possible measures because rating of the health plan is a good indicator of how well the members like their health plan. How fast the health plan pays their claims is not only important to members but it is also important to providers.
| QUALITY MEASURES | RATES | |||||
|---|---|---|---|---|---|---|
| Amerigroup 2007 | Amerigroup 2008 | Peach State 2007 | Peach State 2008 | Wellcare 2007 | Wellcare 2008 | |
| How Well Doctors Communicate1 | 84% | 86% | 89.5% | 86.7% | 88.2% | 88.4% |
| Rating of Health Care2 | 67% | 70% | 67.8% | 68.3% | 61.3% | 75.7% |
| Rating of Personal Doctor2 | 74% | 75% | 75.1% | 76.5% | 68.9% | 75.3% |
| Rating of Health Plan2 | 74% | 66% | 67.2% | 70.1% | 66.6% | 71.5% |
This measure assesses how well providers listen, explain, spend enough time with, and show respect for what members have to say.
Effective communication between physicians and patients is an essential factor to positive outcomes in members' health care.
This question tells how members rate their experience with health care based on how well doctors communicate,
shared decision making with the physicians, custom service, access to care, and getting the care that is needed.
This overall satisfaction measure tells how a member feels about the experience with the primary care physician.
This measure summarizes a member's overall satisfaction with the health plan.
It shows the member's experience with the health plan including access to care and customer service.
