AmeriHealth uses composite scores related to interactions between our
members and their physicians to evaluate
the experience between the two. Information for commercial and Medicare
Advantage members is taken from the
Consumer Assessment of Healthcare Providers and Systems (CAHPS®
). Information for members enrolled in a
Health Insurance Marketplace (Marketplace) plan is taken from the Qualified
Health Plan Enrollee Experience Survey
(QHP® EES). Using these surveys, composite scores are calculated
by the National Committee for Quality Assurance
(NCQA) designated vendor, Morpace Marketing Research and Consulting, and
presented to AmeriHealth once the
results are complete.
Note: Even though the composite indicators are the same, scores are
measured based on questions and measures
unique to commercial, Medicare Advantage, and Marketplace plans.
Commercial plans
CAHPS scoring for commercial plans is measured according to the percentage
of members who answered
?Always/Usually? in regard to the following indicators:
- Getting Care Quickly. The member is able to get care and
appointments as soon as needed.
- Getting Needed Care. The member is able to have an easy
time obtaining the care he or she believes is
necessary and to schedule an appointment with a specialist.
- Coordination of Care. In the last 12 months, the member?s
personal physician has been kept informed and up to
date about the care he or she has received from specialists or other health
care providers.
- How Well Doctors Communicate. The physician shows the
member respect by explaining the information in a
way the member understands, is willing to listen to any questions or concerns,
and spends enough time with the
member.
Member Satisfaction CAHPS ? commercial
plans
| Indicator | AmeriHealth
Pennsylvania | AmeriHealth New Jersey |
|---|
| | HMO | POS | PPO |
|---|
| Getting Care Quickly | 89% | 87% | 84% | 83% |
| Getting Needed Care | 89% | 82% | 89% | 86% |
| Coordination of Care | 85% | 74% | 79% | 82% |
| How Well Doctors Communicate | 96% | 95% | 96% | 96% |
Medicare Advantage plans
CAHPS scoring for Medicare Advantage plans is measured according to the
percentage of members who answered
?Always? in regard to the following indicators:
- Getting Care Quickly. The member receives care as soon as
it is needed (urgent), obtains an appointment as
soon as one is needed (routine), and sees a physician within 15 minutes of the
scheduled appointment time.
- Getting Needed Care. The member is able to have an easy
time obtaining the care and tests he or she believes
are necessary and to schedule an appointment with a specialist.
- Coordination of Care. The physician was in possession of
member medical records; the member had tests
performed when determined it was necessary, and the physician followed up with
test results; discussions were
held regarding prescription medications; the member received assistance in
managing his or her care; and the
physician was kept informed and up to date about care the member has received
from specialists or other health
care providers.
- How Well Doctors Communicate. The physician shows the
member respect by explaining the information in a
way the member is willing to listen to any questions or concerns, and spends
enough time with the member.
Member Satisfaction CAHPS ? Medicare
Advantage plan
| Indicator | AmeriHealth 65® Preferred
HMO |
|---|
| Getting Care Quickly | 48% |
| Getting Needed Care | 62% |
| Coordination of Care | 73% |
| How Well Doctors Communicate | 80% |
Marketplace plans
QHP EES scoring for Marketplace plans is measured according to the
percentage of members with positive answers
with relation to the following indicators:
- Getting Care Quickly. The member is able to get care and
appointments as soon as needed.
- Getting Needed Care. The member is able to have an easy
time obtaining the care he or she believes is
necessary and to schedule an appointment with a specialist.
- Coordination of Care. The physician was in possession of
member medical records; the member had tests
performed when determined it was necessary, and the physician followed up with
test results; discussions were
held regarding prescription medications; the member received assistance in
managing his or her care; and the
physician was kept informed and up to date about care the member has received
from specialists or other health
care providers.
- How Well Doctors Communicate. The physician shows the
member respect by explaining the information in a
way the member understands, is willing to listen to any questions or concerns,
and spends enough time with the
member.
Member Satisfaction QHP EES ? Marketplace
plans
| Indicator | AmeriHealth
New Jersey |
|---|
| HMO | POS | PPO |
|---|
| Getting Care Quickly | 77% | 76% | 78% |
| Getting Needed Care | 73% | 78% | 78% |
| Coordination of Care | 78% | 79% | 84% |
| How Well Doctors Communicate | 85% | 89% | 90% |
Results
When comparing AmeriHealth results verses national results, the experience
of commercial HMO members reports
between the 25th and 90th percentiles for most indicators with the exception of
AmeriHealth New Jersey HMO Getting
Needed Care and Coordination of Care, which reported rates below the 25th
percentile. However, both of these
indicators did demonstrate improvement from 2015. Getting Care Quickly declined
for AmeriHealth New Jersey HMO
and Getting Needed Care declined for AmeriHealth Pennsylvania. The rate for
Coordination of Care for AmeriHealth
New Jersey POS declined in 2016, reporting below the 25th percentile. Even
though the rate for Getting Care Quickly
improved to reach the 50th percentile, the rate for Getting Needed Care
remained essentially unchanged within the
25th percentile.
Reporting for AmeriHealth New Jersey PPO demonstrated a decline in both
Getting Care Quickly and Getting
Needed Care, with CAHPS rates below the 25th percentile. The rate for How Well
Doctors Communicate showed
improvement for all commercial plans, meeting the goal of 90th percentile.
Member experience for AmeriHealth 65 Preferred HMO showed improvements in
Coordination of Care and How Well
Doctors Communicate, reporting at or above Centers for Medicare & Medicaid
Services (CMS) National Distribution.
The remaining indicators remained below the CMS National Distribution.
Composite rates for QHP EES report within the National Distribution for both
POS and PPO. With the exception of
Getting Care Quickly, all indicators for AmeriHealth New Jersey HMO Marketplace
plans reported rates below the
National Average.* Our goal is to reach the 90th percentile or a 5 STAR rating
in the applicable measurement systems
while demonstrating continuous scoring improvement on a year-to-year basis.
Resources available to you
AmeriHealth values our network practitioners and the work involved in
maintaining quality care. We offer a range of
services and opportunities to help you maintain and improve care, including,
but not limited to:
- Care Management Services, including Complex Case Management and Condition
Management (including
Maternity Management)
- Behavioral Health Care services
- Pharmacy services
Additional information is available online for AmeriHealth New
Jersey or in the Resources for Patient Management section for AmeriHealth Pennsylvania or in
the Administrative Tools & Resources section of the NaviNet® web
portal.
* Plan comparison is reported via the NCQA Quality
Compass tool and CMS National Distribution 2016 results. Rates reported for
Medicare
Advantage are from data collected via Morpace, and may be slightly different
than actual CMS reporting.
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