Independence 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, an
independent company, and presented
to Independence 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 | Keystone Health Plan East
(KHPE) | Personal Choice® |
|---|
| Getting Care Quickly | 86% | 88% |
| Getting Needed Care | 89% | 88% |
| Coordination of Care | 82% | 86% |
| How Well Doctors Communicate | 95% | 97% |
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 plans
| Indicator | Keystone 65 HMO | Personal Choice
65SM PPO |
|---|
| Getting Care Quickly | 56% | 59% |
| Getting Needed Care | 64% | 64% |
| Coordination of Care | 71% | 75% |
| How Well Doctors Communicate | 81% | 83% |
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 | KHPE | Personal Choice |
|---|
| Getting Care Quickly | 74% | 78% |
| Getting Needed Care | 76% | 78% |
| Coordination of Care | 85% | 82% |
| How Well Doctors Communicate | 91% | 89% |
Results
When comparing Independence results versus national results, the experience
for KHPE members reports between
the 50th and 90th percentiles, with How Well Doctors Communicate reaching the
goal of the 90th percentile. Overall
evaluation of member satisfaction reports via CAHPS for KHPE members shows an
improvement in all indicators,
with the exception of Getting Care Quickly, which remained unchanged from
2015.
The rates for Personal Choice members report between the 50th and 90th
percentiles for positive outcomes, with How
Well Doctors Communicate also reaching the goal of the 90th percentile. CAHPS
rates for Personal Choice members
improved for Getting Care Quickly and How Well Doctors Communicate, but
declined for Getting Needed Care and
Coordination of Care.
For both Keystone 65 HMO and Personal Choice 65 PPO, member experience
reports at or above the Centers for
Medicare & Medicaid Services (CMS) National Distribution for positive outcomes.
This is unchanged from 2015.
Composite rates for QHP EES report within the National Distribution for both
KHPE and Personal Choice Marketplace
plans.* 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
Independence 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 in the Resources for Patient
Management section
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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independent company.