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Community Health Plans Among Best in Nation
Date:10/26/2007

alth plans achieve high quality care by providing coordinated, effective care for their patients," said Eric H. Schultz, the President and CEO of Fallon Community Health Plan. "Fallon Community Health Plan is involved with patient care at every step, whether it is a hospital stay or a physician visit, in a constant effort to improve the health and experience of our patients."

Unfortunately, among Medicare enrollees, meaningful quality data are not available for the approximately 35 million enrollees in traditional fee-for-service Medicare, nor are these data available for the 1.7 million individuals enrolled in Medicare private fee-for-service plans. These data are available, however, for enrollees in Medicare coordinated care plans. As a result, policymakers cannot truly evaluate the value of Medicare coordinated care against traditional Medicare or private fee-for-service plans because they are missing a large piece of the puzzle -- namely, the impact of the delivery system on quality of care. ACHP supports measuring and publicly reporting information about both the quality of clinical care as well as patient satisfaction with all sectors of the health care system.

Background on the Rankings

The rankings published on October 26, 2007 by the U.S. News and World Report are based primarily on two data sources: the Health Plan Employer Data and Information Set (HEDIS(R)) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS(R)). HEDIS(R) captures whether or not patients receive appropriate care from their providers, while CAHPS(R) captures patients' experience with their providers and health plan. For example, one HEDIS(R) measure tracks the percentage of female patients, aged 40-69, who receive an annual mammogram; the National Cancer Institute, the American Cancer Society, and the American College of Radiology all recommend annual mammograms for women over 40. An example of a CAHPS(R) measure is how patients rank their health pl
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SOURCE Alliance of Community Health Plans
Copyright©2007 PR Newswire.
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