How Our Quality Measures Up
Can quality in health care be measured in the same way we evaluate products like cars and electronics? Group Health believes that just as information aids other kinds of decisions, so it helps individuals make important choices about health care. And research tells us patients who understand their options — and participate fully in treatment — are more likely to experience good outcomes and be satisfied with their care.
We believe that our customers, purchasers, and the public have a right to know objective information about the quality of various health plans to be able to compare and make their health care choices. Therefore, Group Health voluntarily participates in a variety of external audits, performance report cards, and accreditations to monitor our quality performance to make sure we are continuously improving in our identified focus areas, and to compare ourselves against benchmark performers locally and nationally.
HEDIS/CAHPS Performance
The most widely used measurements are NCQA's HEDIS (Healthcare Effectiveness Data and Information Set) for clinical quality and CAHPS (Consumer Assessment of Healthcare Providers and Systems) for service quality. HEDIS performance measures are related to significant public health issues such as cancer screening, heart disease, smoking, asthma, and diabetes. CAHPS is a standardized survey of consumers' experiences that evaluates performance in areas such as satisfaction with clinicians, customer service, access to care and claims processing.
Puget Sound Health Alliance "Community Checkup"
Care offered at Group Health medical centers in the Puget Sound area was compared to that of 45 other delivery system, in a July 2009 report. Group Health was rated in the top category in 11 out of 15 measures, more than any of the other Puget Sound medical groups that were rated on all 15 measures.
National Committee for Quality Assurance (NCQA) Accreditation
"Excellent" status. NCQA's highest accreditation rating is granted only to plans that demonstrate service and clinical quality that meets or exceed NCQA's rigorous requirements for consumer protection and quality improvement. Plans earning this accreditation level must also achieve HEDIS results that are in the highest range of national or regional performance.
U.S. News & World Report America's Best Health Plans — Commercial
This is the fourth year U.S. News and NCQA, managed care's major accrediting and standards-setting body, have teamed up to rank health care plans. Rankings reflect results of consumer surveys and success in preventing and treating illness compared with the average health plan. The highest possible score is 100. Group Health scored 83.1, for a ranking of 97 out of 287 commercial plans.
U.S. News & World Report America's Best Health Plans — Medicare
Group Health's Medicare plan has been recognized as one of "America's Best Health Plans" for the second year in a row by U.S. News and World Report magazine and NCQA. Our plan ranked 23 out of 216 plans.
Centers for Medicare and Medicaid Services (CMS) Medicare Plan Comparisons
CMS provides Web-based plan-rating tools to help Medicare members more easily compare plans based on cost, quality, and performance. Group Health was the highest ranked plan for both "health plan quality" and "prescription drug plan quality," earning 4 out of 5 stars and 4.5 out of 5 respectively.
J.D. Power and Associates Award
In 2008, Group Health had the "Highest Member Satisfaction Among Commercial Health Plans in the Northwest Region" based on member feedback. The study's rankings factors included coverage and benefits; choice of doctors, hospitals, and pharmacies; information and communication, approval processes; claims processing; insurance statements; and customer service.
Other Awards and Recognition
- Ranked first in the nation for HMO plans in 2009 by a well-known consumer magazine based on a survey of 37,000 readers. Group Health was ranked high in reader satisfaction in choice of doctors, access to care, satisfaction among those with chronic conditions, billing, customer service, and online services.
- More than 50 doctors from our medical group were included in the 2009 "top docs" listings in Seattle, Bellevue, and Spokane/Coeur d'Alene magazines, and 19 of our nurses were nominated for the 2008 March of Dimes Nurse of the Year.
- Winner of the Washington State Medical Association's William O. Robertson Patient Safety Award for the innovative on-line reporting system that gives health care teams a simple, non-punitive way to report errors or safety concerns so that systems can be fixed to prevent possible future errors.
- Winner of the 2007 U.S. Frost & Sullivan Award for Technology Leadership, and the MyGroupHealth Web site received the award from NCQA's new Quality Plus "Member Connections" program.
