Maryland Health Insurance Plans Often Similar On Levels of Recommended Care

Maryland Health Plans

New Information Supports Value-Based HealthCare Choices In Maryland.

For the first time, Marylanders can compare how well health maintenance organizations (HMOs) design delivery programs that ensure their members receive recommended care in cost-effective ways. Measuring the Quality of Maryland HMOs and POS Plans: 2007/2008 Performance Report, 11th edition, released today by the Maryland Health Care Commission (MHCC), combines a variety of new information on health insurance plan programs with the familiar clinical and member satisfaction results reported each year.

The new information added to this year's report rates health insurance plans in five categories: consumer engagement, preventive care, disease management, prescription management, and behavioral health care. This information was gathered using eValue8 TM, a tool developed by the National Business Coalition on Health.

"The commission's guide reporting on the quality of Maryland HMO and POS plans informs Marylanders about the performance of our health plans and helps stimulate further improvement in the quality of health care," said Marilyn Moon, chair of the MHCC. "Measures of performance and quality need to be closely monitored, using a variety of measures. That is why I am pleased to see the addition of the eValue8 tool, which adds another dimension to our measurement and reporting capability."

In piloting this new measurement tool, MHCC gathered data from Aetna, CareFirst BlueChoice, Kaiser Permanente, and Optimum Choice, Inc. With high scores in three categories, Kaiser Permanente set the regional benchmarks for preventive care, disease management, and prescription drug management. The strength of Aetna's behavioral health care and consumer engagement programs scored highest; thereby, establishing the regional benchmarks in these program areas.

Change has served as a constant in health plan quality measurement. The measurement set used by MHCC has adapted over time to reflect those areas concerning health improvement and appropriate use of resources. For example, new measures of care have replaced those measures that neared 100 percent. This year's clinical care results include several new items and have an aggregate performance trending in a positive direction for members enrolled in Maryland HMOs. When above, below, and average rates are compared across the span of results in the 2007/2008 Performance Report, the majority of health plan members receive care at about the same frequency.

Top tier performance for clinical and member satisfaction was shared by the seven health plans included in the 2007/2008 Performance Report. Coventry, Kaiser Permanente, and M.D.IPA clustered closely together, having the most above-average results. The measurement set covers preventive care for children and adults, chronic care, behavioral health care, and member satisfaction.

A comparison of Maryland plans with similar plans in the region and nation shows Maryland's best performance was in the Adults' Preventive Care measure category. Average performances with plans in the state compared to those in the region were above average for screening measures: breast cancer screening, screening for Chlamydia, and screening for colorectal cancer. Notably, breast cancer screening rates for the state, region, and nation have declined between 2005--2007. Well-child care measures show a mixed experience when comparing Maryland average rates to the region and nation. Well-care is provided more often to children enrolled in Maryland health insurance plans compared to those enrolled nationally but less often than those enrolled in plans regionally. Opportunities for improvement continue to exist in areas of member satisfaction with their health care.

"This is the 11th year of measurement and reporting on the performance and quality of Maryland's health plans. I am most pleased to see that Maryland's performance overall matches and frequently exceeds that of the region and nation," said John M. Colmers, secretary of the Department of Health and Mental Hygiene. "But there is always room for improvement and although plans are to be commended for their scores on care provided, there is a need for improvement in the area of member satisfaction. Governor O'Malley has a very strong commitment to improve Maryland's health care system. Public reporting of quality is a key part of that effort," Secretary Colmers said.

Vignettes appearing throughout describe plans' initiatives to address health care disparities, a new focus in health plan quality measurement presented for the first time this year. Delegate Shirley Nathan-Pulliam noted, "In 2006, I introduced legislation that required the commission to include information on racial and ethnic health care disparities into their reports. I am pleased to see that the 2007/2008 Performance Report has a special focus on health and health care disparities and health plan efforts to address them. Health plans now have the authority to collect racial and ethnic data at the time of application. It is my sincere hope that they will use this information to improve the health outcomes of their members."

The 2007/2008 Performance Report is available to download for free on MHCC's Web site at: mhcc.maryland.gov. For print or CD copies, please call the MHCC at 410-764-3460 or toll free at 877-245-1762. For more information, please contact Bruce Kozlowski, director of the Center for Health Care Financing and Policy, or Joyce Burton, chief of Health Plan Quality and Performance Division at 410-764-3460.