America's Best Health Plans Rankings: Definitions
Posted November 11, 2009
[See America's Best Health Plans and search for one for you.]
General Terms |
|
|---|---|
| Rank | Based on score. Commercial, Medicare, and Medicaid health plans are evaluated and ranked separately. |
| Score (out of 100) | Based on performance relative to other plans in member satisfaction, prevention and treatment, and accreditation by the National Committee for Quality Assurance. Commercial plans are evaluated in 50 measures, Medicare plans in 44 measures, and Medicaid plans in 41 measures. |
| State | Where plan operates. |
| Type | HMO (health maintenance organization)—primary-care physician provides routine care; specialist network provides other care. Members pay out of pocket for care outside the network. POS (point of service) plan—part of cost of out-of-network care is paid by plan. |
| NCQA accreditation | Indicates conformance with quality-related standards established by the National Committee for Quality Assurance, the major accrediting body for U.S. managed-care organizations. Accreditation is worth 15 points in a plan's score. |
| I | Insufficient data. |
| NA | Not applicable: Benefit is not offered, few members are affected, or (Medicare only) plan is not required to submit the data. |
| NR | Not reported: Plan did not calculate a measure, or calculated but did not report it. |
Commercial Plans |
|
| Member satisfaction: Indicates surveyed members' opinions of their plan's care, services, and physicians. | |
Getting care |
|
| Getting care easily | Indicates proportion of members who said they could get appointments, preventive care, tests, and treatment easily. |
| Getting care quickly | Indicates proportion of members who said they could get appointments, preventive care, tests, and treatment promptly. |
Satisfaction with physicians |
|
| How well doctors communicate | Indicates proportion of members who rated doctors' communication skills as high. |
| Rating personal doctor | Indicates proportion of members who rated their personal physician high overall. |
| Rating specialists | Proportion of surveyed members who rated plan's specialists high overall. |
| Rating care received | Indicates proportion of members who rated their care high overall. |
Satisfaction with health plan services |
|
| Handling claims | Indicates proportion of members who were satisfied with how their claims were handled. |
| Rating health plan | Indicates proportion of members who rated overall plan services high. |
| Customer service | Indicates proportion of members who rated overall customer service high. |
| Prevention: How well plans provide screening, immunizations, and other preventive services. | |
Children and adolescents |
|
| Well-child visits, infants | Indicates proportion of children 15 months old in latest year reported who had at least six well-child visits since birth. |
| Well-child visits, ages 3-6 | Indicates proportion of these children who had at least one well-child visit in latest year reported. |
| Access for children ages 7-11 | Indicates proportion of these children who had a visit with a primary-care physician in latest year reported. |
| Adolescent well-care visits | Indicates proportion of members ages 12 to 21 who had at least one comprehensive well-care visit in latest year reported. |
Women's reproductive health |
|
| Timeliness of prenatal checkups | Indicates proportion of women who gave birth in latest year reported and had a prenatal visit in first trimester. |
| Postpartum care | Indicates proportion of women who gave birth in latest year reported and had a postpartum visit three to eight weeks after delivery. |
Cancer screening |
|
| Breast cancer screening | Indicates proportion of women ages 40 to 69 who had a mammogram. |
| Cervical cancer screening | Indicates proportion of women ages 21 to 64 who had a Pap test. |
| Colorectal cancer screening | Indicates proportion of members ages 50 to 80 who were screened for colorectal cancer. |
Other preventive services |
|
| Early immunizations | Indicates proportion of children who got all recommended immunizations by age 2. |
| Chlamydia screening | Indicates proportion of women ages 16 to 25 who were tested for chlamydia. |
| Treatment: Sums up a plan's performance in treating chronic and acute conditions. | |
Asthma |
|
| Medicate appropriately (5-9 years old) | Indicates proportion of asthmatic children ages 5 to 9 receiving appropriate medication. |
| Medicate appropriately (10-17 years old) | Indicates proportion of asthmatic children ages 10 to 17 receiving appropriate medication. |
| Medicate appropriately (18-56 years old) | Indicates proportion of asthmatic adults ages 18 to 56 receiving appropriate medication. |
Diabetes |
|
| Blood pressure control (130/80) | Indicates proportion of members ages 18 to 75 with type 1 or 2 diabetes whose most recent blood pressure reading was lower than 130/80. |
| Blood pressure control (140/90) | Indicates proportion of members ages 18 to 75 with type 1 or 2 diabetes whose most recent blood pressure reading was lower than 140/90. |
| Retinal eye exams | Indicates proportion of members ages 18 to 75 with type 1 or 2 diabetes who had a retinal exam in latest year reported. |
| Glucose testing | Indicates proportion of members ages 18 to 75 with type 1 or 2 diabetes who had a blood glucose test in latest year reported. |
| Glucose control | Indicates proportion of members ages 18 to 75 with type 1 or 2 diabetes whose blood glucose level was maintained at or below 9 percent in latest year reported. |
| LDL cholesterol screening | Indicates proportion of members ages 18 to 75 with type 1 or 2 diabetes whose LDL cholesterol was checked in latest year reported. |
| LDL cholesterol control | Indicates proportion of members ages 18 to 75 with type 1 or 2 diabetes whose LDL cholesterol was maintained below 100 milligrams per deciliter. |
| Monitoring kidney disease | Indicates proportion of members ages 18 to 75 with type 1 or 2 diabetes whose kidney function was checked in latest year reported. |
Heart disease |
|
| Beta blocker after heart attack | Indicates proportion of members ages 35 and above who had a heart attack and received treatment with a beta blocker for at least six months after discharge. |
| Controlling high blood pressure | Indicates proportion of members ages 18 to 85 who were diagnosed with hypertension and whose most recent blood pressure reading was below 140/90. |
| LDL cholesterol screening | Indicates proportion of members ages 18 to 75 with heart disease whose LDL cholesterol was checked. |
| LDL cholesterol control | Indicates proportion of members ages 18 to 75 with heart disease whose LDL cholesterol was maintained below 100 milligrams per deciliter. |
Mental and behavioral health |
|
| Depression—adhering to medication for 12 weeks | Indicates proportion of members ages 18 and above who were newly diagnosed with depression, prescribed medication, and remained on the drug for the next 12 weeks. |
| Depression—adhering to medication for six months | Indicates proportion of members ages 18 and above who were newly diagnosed with depression, prescribed medication, and remained on the drug for at least six months. |
| Follow-up after hospitalization for mental illness | Indicates proportion of members ages 6 and above who were hospitalized because of mental illness and were seen for follow-up care within a week and again within a month of discharge. |
| Alcohol or drug dependence treatment initiated | Indicates proportion of members ages 13 and above diagnosed with alcohol or drug dependence and treated either as inpatients or outpatients. |
| Alcohol or drug dependence treated for 30 days | Indicates proportion of members ages 13 and above diagnosed with alcohol or drug dependence and provided with at least two related services within 30 days of initial treatment. |
| Follow-up after ADHD diagnosis | Indicates proportion of children ages 6 to 12 initially diagnosed with attention deficit hyperactivity disorder who were prescribed medication and had a visit with a practitioner within 30 days. |
| Continued follow-up after ADHD diagnosis | Indicates proportion of children ages 6 to 12 initially diagnosed with attention deficit hyperactivity disorder who were treated with medication for seven months and had three follow-up visits within nine months. |
Other treatment measures |
|
| Appropriate antibiotic use, adults with acute bronchitis | Indicates proportion of adults ages 18 to 64 who were not prescribed an antibiotic for up to three days after diagnosis of acute bronchitis. |
| Appropriate testing and care, children with pharyngitis | Indicates proportion of children ages 2 to 18 who were diagnosed with a sore throat, prescribed an antibiotic, and tested for strep. |
| Medication for rheumatoid arthritis | Indicates proportion of newly diagnosed members ages 18 and above who were prescribed an appropriate drug. |
| Monitoring key long-term medications | Indicates proportion of members ages 18 and above who were clinically monitored after receiving six-month supply of ACE inhibitors, angiotensin receptor blockers (ARBs), digoxin, diuretics, or anticonvulsants. |
| Steroid after hospitalization for acute COPD | Indicates proportion of members ages 40 and above admitted to hospital, diagnosed with acute chronic obstructive pulmonary disease, and given systemic corticosteroid within 14 days of discharge or episode. |
| Bronchodilator after hospitalization for acute COPD | Indicates proportion of members ages 40 and above admitted to hospital, diagnosed with acute chronic obstructive pulmonary disease, and given bronchodilator within 14 days of discharge or episode. |
| Testing for COPD | Indicates proportion of members ages 40 and above whose diagnosis of chronic obstructive pulmonary disease was confirmed with a spirometry test. |
| Appropriate antibiotic use, children with URI | Indicates proportion of children ages 3 months to 18 years who were not prescribed an antibiotic for up to three days after diagnosis of common cold. |
Medicare Plans |
|
| Member satisfaction: Indicates surveyed members' opinions of their plan's care, services, and physicians. | |
Getting care |
|
| Getting care easily | Indicates proportion of members who said they could get appointments, preventive care, tests, and treatment easily. |
| Getting care quickly | Indicates proportion of members who said they could get appointments, preventive care, tests, and treatment promptly. |
Satisfaction with physicians |
|
| How well doctors communicate | Indicates proportion of members who rated doctors' communication skills as high. |
| Rating personal doctor | Indicates proportion of members who rated their personal physician high overall. |
| Rating specialists | Proportion of surveyed members who rated plan's specialists high overall. |
| Rating care received | Indicates proportion of members who rated their care high overall. |
Satisfaction with health plan services |
|
| Rating health plan | Indicates proportion of members who rated overall plan services high. |
| Customer service | Indicates proportion of members who rated overall customer service high. |
| Prevention: How well plans provide screening, immunizations, and other preventive services. | |
| Breast cancer screening | Indicates proportion of women up to age 69 who had a mammogram. |
| Colorectal cancer screening | Indicates proportion of members up to age 80 who had colorectal cancer screening. |
| Glaucoma screening | Indicates proportion of members who had glaucoma screening. |
| Evaluating mental health status | Indicates proportion of members whose mental health status was assessed at beginning and end of most recently reported two-year period. |
| Evaluating physical health status | Indicates proportion of members whose physical health status was assessed at beginning and end of most recently reported two-year period. |
| Flu shots | Indicates proportion of members who received influenza vaccination. |
| Pneumonia shots | Indicates proportion of members who received pneumonia vaccine. |
| Treatment: Sums up a plan's performance in treating chronic and acute conditions. | |
Diabetes |
|
| Blood pressure control (130/80) | Indicates proportion of members up to age 75 with type 1 or 2 diabetes whose most recent blood pressure reading was lower than 130/80. |
| Blood pressure control (140/90) | Indicates proportion of members up to age 75 with type 1 or 2 diabetes whose most recent blood pressure reading was lower than 140/90. |
| Retinal eye exams | Indicates proportion of members up to age 75 with type 1 or 2 diabetes who had a retinal exam. |
| Glucose testing | Indicates proportion of members up to age 75 with type 1 or 2 diabetes who had a blood glucose test. |
| Glucose control | Indicates proportion of members up to age 75 with type 1 or 2 diabetes whose blood glucose level was maintained at or below 9 percent. |
| LDL cholesterol screening | Indicates proportion of members up to age 75 with type 1 or 2 diabetes whose LDL cholesterol was checked. |
| LDL cholesterol control | Indicates proportion of members up to age 75 with type 1 or 2 diabetes whose LDL cholesterol was maintained below 100 milligrams per deciliter. |
| Monitoring kidney disease | Indicates proportion of members up to age 75 with type 1 or 2 diabetes whose kidney function was checked. |
Heart disease |
|
| Beta blocker after heart attack | Indicates proportion of members who had heart attack and were treated with beta blocker for at least six months after discharge. |
| Controlling high blood pressure | Indicates proportion of members up to age 85 diagnosed with hypertension whose most recent blood pressure reading was below 140/90. |
| LDL cholesterol screening | Indicates proportion of members up to age 75 with heart disease whose LDL cholesterol level was checked. |
| LDL cholesterol control | Indicates proportion of members up to age 75 with heart disease whose LDL cholesterol level was maintained below 100 milligrams per deciliter. |
| Smoking advice | Indicates proportion of smoking members advised by a practitioner to stop. |
Mental and behavioral health |
|
| Depression—adhering to medication for 12 weeks | Indicates proportion of members newly diagnosed with depression for whom drugs were prescribed and who took them for the next 12 weeks. |
| Depression—adhering to medication for six months | Indicates proportion of members newly diagnosed with depression for whom drugs were prescribed and who took them for at least the next six months. |
| Follow-up after hospitalization for mental illness | Indicates proportion of members hospitalized because of mental illness who were seen for follow-up care within a week of discharge and again within a month of discharge. |
| Alcohol or drug dependence treatment initiated | Indicates proportion of members diagnosed with alcohol or drug dependence and treated either as inpatients or outpatients. |
| Alcohol or drug dependence treated for 30 days | Indicates proportion of members diagnosed with alcohol or drug dependence and provided with at least two related services within 30 days of initial treatment. |
Other treatment measures |
|
| Managing risk of falls | Indicates proportion of members who fell or had problems with balance or walking, were seen by their practitioner, and received fall risk intervention. |
| Avoiding harmful drug and disease interactions | Indicates proportion of members with underlying disease, condition, or health concern who did not receive a prescription for drugs considered potentially harmful at time of diagnosis or after. |
| Avoiding high-risk medications | Indicates proportion of members who did not receive medications considered potentially harmful in this age group. |
| Medication for rheumatoid arthritis | Indicates proportion of newly diagnosed members who were prescribed an appropriate drug. |
| Monitoring key long-term medications | Indicates proportion of members being clinically monitored after receiving six-month supply of ACE inhibitors, angiotensin receptor blockers (ARBs), digoxin, diuretics, or anticonvulsants. |
| Steroid after hospitalization for acute COPD | Indicates proportion of members admitted to hospital, diagnosed with acute chronic obstructive pulmonary disease, and given systemic corticosteroid within 14 days of discharge or episode. |
| Bronchodilator after hospitalization for acute COPD | Indicates proportion of members diagnosed with acute chronic obstructive pulmonary disease who were given a bronchodilator within 30 days of hospital discharge. |
| Testing for osteoporosis | Indicates proportion of women who reported having received a bone density test to check for osteoporosis. |
| Managing osteoporosis in women after fracture | Indicates proportion of women ages 67 and above who had a fracture and had bone mineral density test or were prescribed appropriate drugs in next six months. |
| Testing for COPD | Indicates proportion of members whose diagnosis of chronic obstructive pulmonary disease was confirmed with spirometry test. |
| Discussing urinary incontinence | Indicates proportion of members whose physicians discussed urine leakage problem with them during the past six months. |
Medicaid Plans |
|
| Member satisfaction: Indicates surveyed members' opinions of their plan's care, services, and physicians. | |
Getting care |
|
| Getting care easily | Indicates proportion of members who said they could get appointments, preventive care, tests, and treatment easily. |
| Getting care quickly | Indicates proportion of members who said they could get appointments, preventive care, tests, and treatment promptly. |
Satisfaction with physicians |
|
| How well doctors communicate | Indicates proportion of members who rated doctors' communication skills as high. |
| Rating personal doctor | Indicates proportion of members who rated their personal physician high overall. |
| Rating specialists | Proportion of surveyed members who rated plan's specialists high overall. |
| Rating care received | Indicates proportion of members who rated their care high overall. |
Satisfaction with health plan services |
|
| Rating health plan | Indicates proportion of members who rated overall plan services high. |
| Customer service | Indicates proportion of members who rated overall customer service high. |
| Prevention: How well plans provide screening, immunizations, and other preventive services. | |
Children and adolescents |
|
| Well-child visits, infants | Indicates proportion of children 15 months old in latest year reported who had at least six well-child visits since birth. |
| Well-child visits, ages 3-6 | Indicates proportion of these children who had at least one well-child visit in latest year reported. |
| Access for children ages 7-11 | Indicates proportion of these children who had a visit with a primary-care physician in latest year reported. |
| Adolescent well-care visits | Indicates proportion of members ages 12 to 21 who had at least one comprehensive well-care visit in latest year reported. |
Women's reproductive health |
|
| Timeliness of prenatal checkups | Indicates proportion of women who gave birth in latest year reported and had a prenatal visit in first trimester. |
| Postpartum care | Indicates proportion of women who gave birth in latest year reported and had a postpartum visit three to eight weeks after delivery. |
Cancer screening |
|
| Breast cancer screening | Indicates proportion of women ages 40 to 69 who had a mammogram. |
| Cervical cancer screening | Indicates proportion of women ages 21 to 64 who had a Pap test. |
Other preventive services |
|
| Early immunizations | Indicates proportion of children who got all recommended immunizations by age 2. |
| Chlamydia screening | Indicates proportion of women ages 16 to 25 who were tested for chlamydia. |
| Lead screening | Indicates proportion of children ages 2 and above who had a blood test for lead poisoning. |
| Treatment: Sums up a plan's performance in treating chronic and acute conditions. | |
Asthma |
|
| Medicate appropriately (5-9 years old) | Indicates proportion of asthmatic children ages 5 to 9 receiving appropriate medication. |
| Medicate appropriately (10-17 years old) | Indicates proportion of asthmatic children ages 10 to 17 receiving appropriate medication. |
| Medicate appropriately (18-56 years old) | Proportion of asthmatic adults ages 18 to 56 receiving appropriate medication. |
Diabetes |
|
| Blood pressure control (130/80) | Indicates proportion of members ages 18 to 75 with type 1 or 2 diabetes whose most recent blood pressure reading was lower than 130/80. |
| Blood pressure control (140/90) | Indicates proportion of members ages 18 to 75 with type 1 or 2 diabetes whose most recent blood pressure reading was lower than 140/90. |
| Retinal eye exams | Indicates proportion of members ages 18 to 75 with type 1 or 2 diabetes who had a retinal exam in latest year reported. |
| Glucose testing | Indicates proportion of members ages 18 to 75 with type 1 or 2 diabetes who had a blood glucose test in latest year reported. |
| Glucose control | Indicates proportion of members ages 18 to 75 with type 1 or 2 diabetes whose blood glucose level was maintained at or below 9 percent in latest year reported. |
| LDL cholesterol screening | Indicates proportion of members ages 18 to 75 with type 1 or 2 diabetes whose LDL cholesterol was checked in latest year reported. |
| LDL cholesterol control | Indicates proportion of members ages 18 to 75 with type 1 or 2 diabetes whose LDL cholesterol was maintained below 100 milligrams per deciliter. |
| Monitoring kidney disease | Indicates proportion of members ages 18 to 75 with type 1 or 2 diabetes whose kidney function was checked in latest year reported. |
Heart disease |
|
| Controlling high blood pressure | Proportion of members ages 18 to 85 who were diagnosed with hypertension and whose most recent blood pressure reading was below 140/90. |
| LDL cholesterol screening | Proportion of members ages 18 to 75 with heart disease whose LDL cholesterol was checked. |
| LDL cholesterol control | Proportion of members ages 18 to 75 with heart disease whose LDL cholesterol was maintained below 100 milligrams per deciliter. |
| Smoking advice | Proportion of smoking members ages 18 and above who were advised by a practitioner to stop. |
| Stop-smoking strategies | Proportion of smoking members ages 18 and above who discussed methods or strategies for quitting with a practitioner. |
| Stop-smoking medications | Proportion of smoking members ages 18 and above who discussed medications for quitting with practitioner. |
Other treatment measures |
|
| Follow-up after ADHD diagnosis | Indicates proportion of children ages 6 to 12 initially diagnosed with attention deficit hyperactivity disorder who were prescribed medication and had a visit with a practitioner within 30 days. |
| Appropriate antibiotic use, adults with acute bronchitis | Indicates proportion of adults ages 18 to 64 who were not prescribed an antibiotic for up to three days after diagnosis of acute bronchitis. |
| Appropriate testing and care, children with pharyngitis | Indicates proportion of children ages 2 to 18 who were diagnosed with a sore throat, prescribed an antibiotic, and tested for strep. |
| Monitoring key long-term medications | Indicates proportion of members ages 18 and above being clinically monitored after receiving six-month supply of ACE inhibitors, angiotensin receptor blockers (ARBs), digoxin, diuretics, or anticonvulsants. |
| Appropriate antibiotic use, children with URI | Indicates proportion of children ages 3 months to 18 years who were not prescribed an antibiotic for up to three days after diagnosis of common cold. |
Reader Comments
Insufficient data
What does "Insufficient" mean when it is applied to the plan ranking? Is this better or worse than not reporting data at all?
Geat service
This is a great service. I was impressed at the long list of treatment parameters that were examined to come up with the ratings. If there were a wish list, however, I would add more on the preventitive end - for example did obese persons get counseling and help. And of course rates and recent changes in rates don't figure at all-- an item of great interest.
One thing that sticks out for me is that some states, including Nevada, the one of interest to me, do not have a single offering with good ratings........ whereas people in other states have several choices.
A lot of work was expended here,and it's definitely in a direction that will help consumers.
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