About the Reports

CCHRI's voluntary collaborative approach to collecting and reporting important healthcare information has helped drive quality measurement and improvement in California.  Health plans are able to use the results for their own quality improvement efforts and, since the start of public reporting in 1994, there have been significant advances in patient care and satisfaction according to CCHRI health plan results.  All survey and clinical data are collected using uniform processes and guidelines and undergo a rigorous audit by an independent third party.  As a result, the scores listed here are valid and comparisons can be made on an apples-to-apples basis.  Results from other, non-CCHRI health plans may not be comparable because of differences in how data were collected or audited.

Clinical Measures

Findings for the clinical and service measures were obtained from data collected by CCHRI participating health plans.  Results are based on HEDIS© Effectiveness of Care and Access/Availability of Care measurement and reporting guidelines developed by the National Committee for Quality Assurance (NCQA).  HEDIS is the most widely used set of performance measures in the health care industry and, when used with the NCQA-approved Member Survey, helps identify health plan successes in providing preventive care, chronic care management and other medical services for health plan members.  Results were collected in 2009 and reflect the percentage of sampled members who received the specific services during 2008, or in prior years for a few of the measures.  To read about the clinical measures click here.

Member Experience

The member experience with their health plan results were collected in a member survey developed by the National Committee for Quality Assurance (NCQA).  Results include the percentage of sampled members who responded favorably to questions about their health plan or medical care and are based on random samples of participating health plan members (minimum sample size per plan = 1100).  The survey was conducted during 2009 but reflects information about medical care and services provided to members during 2008.

How to Interpret the Results

When reviewing the results, please compare each plan to the benchmark and not to the other plans.  Most ratings are based on a small sample of health plan members.  As a result, small differences in the results between plans may not be statistically significant or meaningful.

CCHRI defines three performance strata.  Their calculation incorporates statistical significance testing based on the 95% confidence interval around each measure rate as follows:

1. Above the National Average:  Lower Bound of Confidence Interval > National Average
2. Same as the National Average:  Confidence Interval Encompasses National Average
3. Below the National Average:  Upper Bound of Confidence Interval < National Average

It is possible for measures with a very large denominator population and, therefore, a narrow confidence interval that a plan's upper confidence interval bound is < national average when taken out to several decimal places (but with the same rounded integer percent rate).

Results listed are for commercial HMO and PPO members and Medicare managed care members only; Medi-Cal beneficiaries covered under a managed care plan are not included.  Use caution when comparing HMO to PPO results, since some HMO measures allow for chart review while PPO measures are based solely on claims data.  In addition, not all HMO plans have a PPO product; therefore, the PPO cross-plan averages are based on a subset of the HMO plans.

* The Medicare data includes results for two SCAN plans.  The SCAN Legacy plan was previously a demonstration Social HMO and currently has 97% of membership enrolled in an Institutional Living in the Community Special Needs Plan.  The SCAN Classic plan is similar to the other Managed Medicare plans.

Acknowledgements

Each year CCHRI participants and supporting organizations distinguish themselves through their cooperation, teamwork, and the generous time they give to our projects.  CCHRI gratefully acknowledges the leadership and commitment shown by the following individuals and Committees:

Leah Smith, Health Net, Chairperson, and Coleen Patania, Anthem, Vice Chairperson, and the other members of the Health Plan HEDIS Data Collection Project Committee, for guiding CCHRI through another challenging and successful year;

The Patient Assessment Survey Project Committee, for refining and implementing the PAS survey of patient experience with medical groups and IPAs;

The Member Survey Project Committee, for providing guidance and input to the CAHPS survey and reporting process;

The Provider After-Hours Access Survey Project Committee for providing leadership and direction for refining and implementing the Provider After-Hours Survey;

Sharon Ricciuti, PacifiCare, CCHRI Reporting Committee chairperson, and the other members of the Reporting Committee, for their focus and hard work in consistently offering constructive and objective recommendations about many complex and sensitive reporting decisions.

CCHRI is also grateful for the important contributions made by the following organizations:

Thomson Reuters for the important role they fill in supporting the Health Plan HEDIS Data Collection Project.  In particular, we acknowledge the dedication and support provided by Marlise Goodwin and Mahil Senathirajah.

Center for the Study of Services (CSS) for administering the Patient Assessment Survey and providing analytical and reporting support to the project.  In particular we acknowledge the contributions of Jeff Burkeen.

DSS Research, for successfully fielding and reporting the CAHPS Member Survey Project.

NATO, for successfully fielding and reporting the Provider After-Hours Access Survey.

CCHRI Senior Manager
Cathie Markow, PBGH
cmarkow@pbgh.org

Reporting Principles

Guidelines for Use of Data

About the Reports

Clinical Measure Descriptions