Health Plan Report Cards | Homeworkcrew

Health Plan Report Cards | Homeworkcrew

Report cards are one means by which MCOs are measured against the other.  Health information systems help with reporting. The links for report cards listed below are a few examples of what is reported to the public by accreditation agencies, by employer groups, by regulators and more.  In examining the report cards, note that there are structure, process and outcome measures.  Consider the report cards listed below and the value of measuring outcomes and processes.  Given the different rates of achievement for the MCOs, consider how the results influence you as a consumer.  As an educated consumer, it is also important to understand what might be driving the rates. 

These online resources provide sample report cards and other information that should help you understand the report cards:

Medicare STARS rates how well plans perform based on a cross section of quality metrics including clinical, pharmacy, member satisfaction with their plan (as well as providers), health outcomes and plan operations. The ratings range between 1 and 5.  Medicare is eliminating plans that fail to reach and maintain its expectations.

In addition, Medicare provides a website called Medicare Plan Finder where you can find and compare the following and more:

  • MCOs
  • Physicians
  • Home Health
  • Hospital

The following links provide report cards and the rates are updated yearly. The NCQA provides the report cards for plans accredited by NCQA.  Also, explore the other reports cards for physician groups and other health agencies.

Other report cards include, but are not limited to:

  • Hospital compare – Leapfrog
  • Individual Clinician Performance Information on Physician Compare, 2017
  • Emergency services – ACEP 2014 EM Report Card 

States also compare their MCOs. For example,  

  • Vermont Hospital Report Cards
  • North Carolina State Center for Health Statistics
  • The New York State Department of Health (NYSDOH) compares rates for multiple MCOs

Still, other report cards include, but are not limited to:

  • Quality Check addresses quality reports on a state’s hospitals for multiple quality measures
  • Health Grades addressed physicians, hospitals and nursing homes

After reviewing the websites coupled with the reading assigned, address the following questions in the discussion area:

  • How might the different models of care impact quality?
  • How do stakeholders influence influence the outcomes?
  • How does public reporting as noted by the report cards impact consumer decisions in receiving and satisfaction with care, and influence the future of managed care?  Consider provider payment, quality of care received, rates from one MCO vs. another for specific rates and more.
  • Research and share a link where you found another report card with measures that interests you.  Compare the rates with another MCO.  How do the rates compare to the benchmarks?   How will the content of report cards influence your behavior in the future?

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