Healthcare : Ensuring Quality Healthcare (2024)

  • Healthcare Quality Results
  • Consumer Satisfaction Survey Results

Results for coverage in 92683

Healthcare Quality Results

To help you select a health plan that meets your needs and your family’s healthcare needs, we developed a quality evaluation system using Healthcare Effectiveness Data and Information Set (HEDIS®) metrics that allows you to gauge health plan performance for significant health issues, including:

  • Preventive Care
  • Chronic Disease Management
  • Medication Use
  • Behavioral Health
  • Utilization Management

HEDIS metrics are a set of standardized performance measures that allow you to compare Federal Employees Health Benefits (FEHB) health plan performance to industry benchmark percentiles of plan performance using the key below. Plans are displayed based on their average performance on the first three quality measures.

Healthcare Effectiveness Data and Information Set
Plan Name Controlling High Blood Pressure Healthcare : Ensuring Quality Healthcare (1)

People with high blood pressure receive effective treatment.

Hemoglobin A1c Control for Patients with Diabetes Healthcare : Ensuring Quality Healthcare (2)

Do people with diabetes have their condition under control?

Timeliness of Prenatal Care Healthcare : Ensuring Quality Healthcare (3)

Pregnant women receive care in the first trimester.

Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis Ages 18 to 64 Healthcare : Ensuring Quality Healthcare (4)

Appropriate use of antibiotics for acute bronchitis.

Asthma Medication Ratio Healthcare : Ensuring Quality Healthcare (5)

Appropriate ratio of controller medications to total asthma medications.

Breast Cancer Screening Healthcare : Ensuring Quality Healthcare (6)

Do women who need screening mammograms get them?

Follow Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence 30 day Healthcare : Ensuring Quality Healthcare (7)

Follow up appointment within 30 days of discharge.

Follow Up After Emergency Department Visit for Mental Illness 30 day Healthcare : Ensuring Quality Healthcare (8)

Follow up appointment within 30 days of discharge.

Well Child Visits in First 30 Months of Life, First 15 Months Healthcare : Ensuring Quality Healthcare (9)

Recommended well child visits completed.

Use of Imaging Studies for Low Back Pain Healthcare : Ensuring Quality Healthcare (10)

Appropriate treatment of lower back pain.

Key: Outstanding Excellent Good Fair Poor NA

NA is displayed if a plan did not report or is unable to report a result in this coverage area.

Kaiser Permanente - Southern California , High (62) Excellent Fair Excellent Outstanding Excellent Outstanding Excellent Outstanding Good Outstanding
Kaiser Permanente - Southern California , Standard (62) Excellent Fair Excellent Outstanding Excellent Outstanding Excellent Outstanding Good Outstanding
Kaiser Permanente - Southern California , Prosper (FL) Excellent Fair Excellent Outstanding Excellent Outstanding Excellent Outstanding Good Outstanding
Panama Canal Area Benefit Plan, High (43) Fair Outstanding Data Not Available Data Not Available Data Not Available Poor Data Not Available Data Not Available Data Not Available Excellent
Foreign Service Benefit Plan, High (40) Good Excellent Fair Good Outstanding Fair Fair Excellent Poor Excellent
MHBP - Standard and Value, Value (41) Fair Excellent Excellent Fair Good Poor Fair Poor Poor Fair
MHBP - Standard and Value, Standard (45) Fair Excellent Excellent Fair Good Poor Fair Poor Poor Fair
MHBP Consumer Option, HDHP (48) Fair Excellent Excellent Fair Good Poor Fair Poor Poor Fair
GEHA Indemnity Benefit Plan, Elevate Plus (25) Fair Poor Fair Excellent Good Fair Poor Good Good Excellent
GEHA Indemnity Benefit Plan, Elevate (25) Fair Poor Fair Excellent Good Fair Poor Good Good Excellent
Health Net of California, High (LP) Fair Good Excellent Fair Poor Excellent Fair Fair Poor Good
Health Net of California, Basic (P6) Fair Good Excellent Fair Poor Excellent Fair Fair Poor Good
Health Net of California, Standard (P6) Fair Good Excellent Fair Poor Excellent Fair Fair Poor Good
APWU Health Plan, CDHP (47) Fair Fair Fair Fair Poor Poor Poor Poor Poor Good
NALC, High (32) Excellent Fair Fair Poor Good Fair Fair Fair Poor Fair
Rural Carrier Benefit Plan, High (38) Good Good Excellent Poor Fair Poor Excellent Good Poor Fair
Anthem Blue Cross Select HMO , High (B3) Good Fair Good Fair Poor Excellent Poor Poor Poor Fair
GEHA Benefit Plan, High (31) Good Poor Good Fair Good Fair Fair Fair Good Good
GEHA Benefit Plan, Standard (31) Good Poor Good Fair Good Fair Fair Fair Good Good
GEHA Benefit Plan, HDHP (34) Good Poor Good Fair Good Fair Fair Fair Good Good
Aetna Open Access, High (2X) Fair Fair Poor Fair Fair Fair Poor Poor Poor Good
Aetna HealthFund HDHP and Aetna Direct Plan, HDHP (22) Poor Poor Poor Fair Fair Fair Good Fair Fair Excellent
Aetna HealthFund CDHP and Aetna Value Plan, CDHP (JS) Poor Poor Poor Fair Fair Fair Good Fair Fair Excellent
Aetna HealthFund CDHP and Aetna Value Plan, Value (JS) Poor Poor Poor Fair Fair Fair Good Fair Fair Excellent
Aetna HealthFund HDHP and Aetna Direct Plan, CDHP (N6) Poor Poor Poor Fair Fair Fair Good Fair Fair Excellent
Aetna Advantage Plan, Advantage (Z2) Poor Poor Poor Fair Fair Fair Good Fair Fair Excellent
Blue Cross and Blue Shield Service Benefit Plan, Standard (10) Fair Fair Good Poor Good Good Excellent Good Good Fair
Blue Cross and Blue Shield Service Benefit Plan, Basic (11) Fair Fair Good Poor Good Good Excellent Good Good Fair
Blue Cross and Blue Shield Service Benefit Plan, FEP Blue Focus (13) Fair Fair Good Poor Good Good Excellent Good Good Fair
Compass Rose Health Plan, High (42) Fair Fair Fair Fair Outstanding Good Data Not Available Data Not Available Fair Poor
NALC, CDHP (32) Poor Poor Poor Good Poor Poor Poor Fair Poor Fair
SAMBA, High (44) Fair Poor Poor Poor Excellent Fair Data Not Available Data Not Available Poor Fair
SAMBA, Standard (44) Fair Poor Poor Poor Excellent Fair Data Not Available Data Not Available Poor Fair
APWU Health Plan, High (47) Poor Poor Poor Poor Good Poor Good Fair Poor Good

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Consumer Satisfaction Survey Results

Each year Federal Employees Health Benefits (FEHB) plans send the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey to a sample of plan members to evaluate their health plan experiences in key areas, including:

  • Communication
  • Access
  • Claims
  • Member Experience/Engagement

CAHPS® metrics are a set of standardized performance measures that allow you to compare Federal Employees Health Benefits (FEHB) health plan performance to industry benchmark percentiles of plan performance using the key below. Plans are displayed based on their average performance on the first three quality measures.

Consumer Assessment of Healthcare Providers and Systems
Plan Name Getting Needed Care Healthcare : Ensuring Quality Healthcare (11)

Members report getting the care they need.

Claims Processing Healthcare : Ensuring Quality Healthcare (12)

How quickly do customers say the plan handles claims?

Overall Plan Satisfaction Healthcare : Ensuring Quality Healthcare (13)

How pleased are customers with the plan overall?

Coordination of Care Healthcare : Ensuring Quality Healthcare (14)

Members say that their doctors know about care from other providers.

Key: Outstanding Excellent Good Fair Poor NA

NA is displayed if a plan did not report or is unable to report a result in this coverage area.

Blue Cross and Blue Shield Service Benefit Plan, Standard (10) Fair Good Excellent Poor
Blue Cross and Blue Shield Service Benefit Plan, Basic (11) Poor Good Excellent Poor
Blue Cross and Blue Shield Service Benefit Plan, FEP Blue Focus (13) Poor Data Not Available Fair Data Not Available
Aetna HealthFund HDHP and Aetna Direct Plan, HDHP (22) Poor Data Not Available Fair Data Not Available
GEHA Indemnity Benefit Plan, Elevate Plus (25) Fair Poor Fair Poor
GEHA Indemnity Benefit Plan, Elevate (25) Poor Poor Fair Poor
Aetna Open Access, High (2X) Data Not Available Data Not Available Good Data Not Available
GEHA Benefit Plan, High (31) Good Good Outstanding Good
GEHA Benefit Plan, Standard (31) Excellent Data Not Available Good Data Not Available
NALC, High (32) Excellent Good Excellent Fair
NALC, CDHP (32) Poor Data Not Available Fair Data Not Available
GEHA Benefit Plan, HDHP (34) Fair Poor Fair Poor
Rural Carrier Benefit Plan, High (38) Excellent Excellent Excellent Fair
Foreign Service Benefit Plan, High (40) Fair Good Excellent Poor
MHBP - Standard and Value, Value (41) Outstanding Data Not Available Excellent Outstanding
Compass Rose Health Plan, High (42) Excellent Good Outstanding Fair
Panama Canal Area Benefit Plan, High (43) Outstanding Fair Outstanding Good
SAMBA, High (44) Outstanding Good Outstanding Outstanding
SAMBA, Standard (44) Fair Good Excellent Poor
MHBP - Standard and Value, Standard (45) Excellent Excellent Outstanding Good
APWU Health Plan, High (47) Excellent Fair Excellent Fair
APWU Health Plan, CDHP (47) Excellent Poor Good Fair
MHBP Consumer Option, HDHP (48) Poor Data Not Available Good Data Not Available
Kaiser Permanente - Southern California , High (62) Poor Data Not Available Good Poor
Kaiser Permanente - Southern California , Standard (62) Poor Data Not Available Good Poor
Anthem Blue Cross Select HMO , High (B3) Data Not Available Data Not Available Data Not Available Data Not Available
Kaiser Permanente - Southern California , Prosper (FL) Poor Data Not Available Good Poor
Aetna HealthFund CDHP and Aetna Value Plan, CDHP (JS) Poor Data Not Available Fair Data Not Available
Aetna HealthFund CDHP and Aetna Value Plan, Value (JS) Poor Data Not Available Fair Data Not Available
Health Net of California, High (LP) Poor Data Not Available Fair Poor
Aetna HealthFund HDHP and Aetna Direct Plan, CDHP (N6) Poor Data Not Available Fair Data Not Available
Health Net of California, Basic (P6) Poor Data Not Available Fair Poor
Health Net of California, Standard (P6) Poor Data Not Available Fair Poor
Aetna Advantage Plan, Advantage (Z2) Poor Data Not Available Fair Data Not Available

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  • Healthcare Effectiveness Data and Information Set (HEDIS®), source of the data presented on this web page, is a registered trademark of the National Committee for Quality Assurance (NCQA). View more information on the collection and assessment of HEDIS.
  • The HEDIS® measures and specifications were developed by and are owned by the National Committee for Quality Assurance ("NCQA"). The HEDIS measures and specifications are not clinical guidelines and do not establish standards of medical care. NCQA makes no representations, warranties, or endorsem*nt about the quality of any organization or physician that uses or reports performance measures or any data or rates calculated using the HEDIS measures and specifications and NCQA has no liability to anyone who relies on such measures or specifications. © 2012-2015 National Committee for Quality Assurance, all rights reserved.
  • The data contained herein is protected by copyright and other intellectual property laws or treatises. Reproduction or use of the data requires permission of NCQA and is subject to a license at the discretion of NCQA. Unauthorized copying or use if prohibited.
Healthcare : Ensuring Quality Healthcare (2024)

FAQs

What are the 3 C's of quality in healthcare? ›

Perspective: Consistency, Continuity, and Coordination—The 3Cs of Seamless Patient Care. Amid our efforts to improve health care quality, we can easily lose sight of the most basic questions. Consider evidence-based clinical guidelines, protocols, and pathways.

What makes healthcare quality? ›

Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes. It is based on evidence-based professional knowledge and is critical for achieving universal health coverage.

What are the 4 domains of healthcare quality? ›

The CPHQ content covers four domains of practice: Organizational Leadership, Health Data Analytics, Performance Measurement and Process Improvement, and Patient Safety.

What are the six key characteristics of a high quality healthcare system? ›

Healthcare organizations have been using a quality improvement framework consisting of six attributes — safe, effective, patient-centered, timely, efficient, and equitable — for decades.

How is quality measured in healthcare? ›

Quality measures are typically developed based on evidence generated through research and clinical practice, with most measures beginning as clinical guidelines. Developers of measures include: Public agencies (e.g., the CMS and the Agency for Healthcare Research and Quality [AHRQ])

How to ensure data integrity in healthcare? ›

Strategies to Ensure Data Integrity

Regular security audits and assessments are also crucial. Compliance with regulatory standards: Adherence to the Health Insurance Portability and Accountability Act (HIPAA) is critical for maintaining patient data privacy and legal compliance.

Why is accuracy important in healthcare? ›

The following are key reasons highlighting the importance of medical data accuracy: Patient Safety: Accurate medical data ensures that healthcare providers have reliable information about a patient's medical history, allergies, medications, and previous treatments.

Which is the best measure for the quality of care? ›

Outcomes measurement is in some ways the ultimate form of quality measurement because what interests most people is whether care has improved the patient's health.

What are the 3 components of quality health care? ›

There are three main components of quality of care. They are being effective, safe, and patient-centered. These help to govern decisions on desired outcome.

How can we ensure basic health care? ›

Ensuring health access means serving those most in need of health care through Medicaid, medical financial assistance, charitable health coverage, and other forms of subsidized care and coverage.

What are the three quality measures in healthcare? ›

There are different types of quality measures, and they are usually categorized into four categories: process, outcome, structural, and balancing measures.

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