Health Plan Technical Information
Maryland Health Care Commission (MHCC) is committed to promoting improvements in health care by reporting on the quality and performance of health benefit plans operating in the State of Maryland. In 1997, Maryland became the first state in the nation to release a comprehensive health benefit plan “report card” that contained audited data on health maintenance organizations (HMOs). In 2008, Maryland was again the first state to provide consumers with audited, comparative analyses of clinical and member satisfaction measures for preferred provider organizations (PPOs). Health plans in this guide are rated using a 5-star scale. There are three individual measurement areas used in calculating this star rating: HEDIS, CAHPS, and behavioral health (BHA).
The NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is a proprietary data tool that reports on how health plans are performing. These measures include care for respiratory conditions, cardiovascular care, women’s health, musculoskeletal disease, and general primary care and wellness. You can learn more at http://www.ncqa.org/hedis-quality-measurement.
The CAHPS health plan survey, developed by the Agency for Healthcare Research and Quality (AHRQ), collects responses on the overall experience and satisfaction of plan enrollees. It includes a standardized set of questionnaires and supplemental items and can serve as a tool for performance evaluation and improvement in consumer experience. More information and the CAHPS survey can be found at http://www.ahrq.gov/cahps/surveys-guidance/hp/index.html.
The Maryland Plan Behavioral Health Assessment (BHA) is a Maryland-specific quality measurement instrument that details the health benefit plan’s behavioral health care provider network. Information provided by the tool includes total counts of members with behavioral health benefits, counties and jurisdictions where the health benefit plan operates and services are offered, total counts of practicing primary care and behavioral health care providers, accreditation status for the behavioral health care services program, and percentage of psychiatrists that are board certified.
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