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 5 individual measurement areas used in calculating this star rating: HEDIS, CAHPS, RELICC, behavioral health (BHA), and quality profile (QP).
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 Race/Ethnicity, Language, Interpreters, and Cultural Competency Assessment (RELICC™) is a quality measures tool used by health insurance carriers to assist in identifying and developing plans for eliminating health disparities. A major objective of RELICC is to ensure that health plans are providing culturally sensitive and appropriate care. Responses are evaluated, in part, based on methods used to capture information on race, ethnicity, and spoken languages; cultural knowledge of staff and a diverse workforce; the applications of race, ethnicity, and language data to improve customer care, and the impact of language assistance activities.
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.
The Maryland Health Plan Quality Profile (QP) is a Maryland-specific quality measurement instrument from which each health insurance carrier offers a summary of current Maryland initiatives implemented by the health benefit plans. The focus is on the core theme of “understanding and addressing health care disparities.” Initiatives centered on this focus include the steps taken by each organizations leaders towards developing and implementing programs that reflect changes in demographics, required services, and patient and provider expectations.