Network Health Plan's 2007 HEDIS & CAHPS Results

How does a health insurance company measure quality?

Network Health Plan (NHP) is able to evaluate the quality of care and services provided to its members from a variety of perspectives by utilizing nationally recognized tools such as the Healthcare Effectiveness Data and Information Set (HEDIS®) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) scores.  

The HEDIS report is a series of measurements that evaluates preventive care as well as care for chronic diseases.  The CAHPS survey measures customer satisfaction with services provided by customer service, claims, and physicians.   HEDIS and CAHPS are tools that help both employers and consumers compare the quality of care and service offered by an individual health plan to that of others across the country.  

The following table outlines selected 2007 HEDIS results and compares NHP to national and state HMO averages.  NHP has placed in the nation’s top tenth percentile for these measures and has retained its excellent rating as a health plan!  

2007 Network Health Plan HEDIS® Results:      

 Area Studied  Network Health Plan Results  National Average Results  Wisconsin Average Results
 Childhood Immunizations - Combo 3 (fully immunized) 85%   64%  81%
 Childhood Immunizations - Pneumoccoccal Conjugate  92%  71%  87%
 Childhood Immunizations - DTaP/DT  94%  87%  92%
 Adolescent Immunizations - VZV  88%  60%  72%
 Well-Child Visits inthe first 15 Months of Live (6 or more visits)  96%  68%  82%
 Cholesterol Management for members with cardiovascular conditions (screen)  96%  87%  89%
 Cholesterol Management for members with cardiovascular conditions - Control <100 mg/dL  73%  56%  65%
 Comprehensive Diabetic Care - Eye Exam  77%  55%  73%
 Diabetic LDL - Testing 89%   83%  85%
 Diabetic LDL - Control (<100 mg/dL)  55%  43%  50%
 Diabetic Poor HbA1c - Control (note: lower percentage is desirable) 16%  28%   19%
 Asthma Management Children (ages 5-9 years)  100%  96%  97%
 Cervical Cancer Screening Rate  90%  80%  83%
Colorectal Cancer Screening  66%  52%  61%
 Disease Modifying Anti-Rheumatic Drug Therapy In Rheumatoid Arthritis  94%  85%  91%
 Spiometry Testing - COPD  49%  35%  37%

2007 Network Health Pla CHAPS 4.0H Results

 Category/Measure  Network Health Plan Result National Average   Wisconsin National Average
 NHP Customer Service Giving Needed Information of Help 84% 74%  79%

Network Health Plan has contracted with The Myers Group (TMG), a National Committee for Quality Assurance (NCQA) certified HEDIS Survey vendor to conduct the 2008 CAHPS survey.  If you are a Network Health Plan member and receive a request from TMG to complete a CAHPS survey, please share the positive quality of care services you have experienced and return the survey to TMG.  We value your opinion!          

 Each year Network Health Plan’s Quality Improvement (QI) department updates its QI Program structure which includes:

  • a written description of the QI program
  • behavioral health care is specifically addressed in the program description
  • patient safety is specifically addressed in the program description
  • the QI program is accountable to the governing body
  • a designated physician has substantial involvement in the QI program a designated behavioral health care practitioner is involved in the behavioral health care aspects of the QI program
  • a QI Committee oversees the QI functions of the organization the specific role, structure, and function of the QI Committee and other committees, including meeting frequency, are address in the program description
  • an annual work plan
  • a description of resources that the organization devotes to the QI program.  

For more information about Network Health Plan’s Quality Improvement Program, please call NHP’s Quality Improvement department at 920-720-1655, or toll-free at 800-826-0940, ext. 1655.