Every year many Americans have to select a health plan for the next year. It is intuitive to check on the costs, deductibles and the co-pays for each of the plans you are interested. Some people even go as far as checking to see which providers or practices are in the network for the different health plans. These days, with the increasing cost of health care and more people becoming proactive with their care, many people are checking on the quality of their health plans. People are starting to check on health plan ratings to see how much different health plans value providing quality care to patients. There are published annual health plan ratings that people can take advantage of to investigate the quality of care for their plans. The plan ratings are usually based on patient satisfaction, prevention and treatment.
Healthcare Plans with HEDIS Measures
As a healthcare plan, it is important to understand having a high health plan rating to show potential plan patients that you value quality of care. One way a health plan can be rated is through the National Committee for Quality Assurance (NCQA) with using the Healthcare Effectiveness Data and Information Set (HEDIS) measures. The method is similar to the Centers for Medicare and Medicaid Services (CMS) five-star quality rating system. HEDIS is one of health care’s most widely used performance improvement tool. HEDIS measures 6 domains of care that include: effectiveness of care, access/availability of care, experience of care, utilization and risk adjusted utilization, health plan descriptive information, and measures collected using electronic clinical data systems. Each domain consists of various specific measures that contribute to the overall measure. For instance, effectiveness of care domain involves prevention and screening assessment measures and testing for respiratory conditions. Currently, there are more than 190 million people that are enrolled in health plans that utilize the HEDIS measures to report their quality of care and use as an improvement tool.
Work with Chart Review Nurses today!
If you’re interested in learning more about the HEDIS measures, reach out to our experts at Chart Review Nurses by calling us today at (877) 328-2343! Our HEDIS specialists are knowledgeable in the HEDIS measures and are experienced in helping your health plan with implementing and reporting of HEDIS measures. Do not wait to have your health plan rated on the quality of care you provide for patients. Patients are now interested in a plan that values the quality of care provided for patients.
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