| Last Updated: December 22, 2006 |
Care Choices HMO Quality Information
 U.S.
News & World Report/NCQA
NCQA
Accreditation
CAHPS
Results
HEDIS
Results
AM
Best Rating
If you would like information on Care Choices HMO Quality program,
our program goals and our progress toward meeting those goals,
please call our Health and Quality Improvement department at (248)
489-6327.
 U.S. News & World Report/NCQA "America's Best Health Plans" 2006
According to the U.S. News & World Report/NCQA "America's Best Health Plans" 2006 report - Care Choices HMO is ranked 12th among 253 Commercial plans nationwide and the top-ranked health plan in Michigan for the second year in a row.
The publication's online
report enables consumers to view specific information about
how health plans compare on a number of meaningful measures including
access to care, prevention, treatment and overall customer satisfaction.
[Top]
 NCQA Accreditation
Accreditation
by the National Committee for Quality Assurance (NCQA) in an
important measure of quality. Care Choices HMO has received NCQA's
highest rating of "Excellent."
| Area of Focus |
NCQA Rating |
| Overall health plan performance |
"Excellent" rating |
| Getting better |
 out
of 4 |
| Living with illness |
out
of 4 |
| Qualified providers |
out
of 4 |
| Staying healthy |
out
of 4 |
| Access and Service |
out
of 4 |
|
[Top]
Consumer Assessment of Healthcare Providers and Systems (CAHPS)® Results
CAHPS measures members' satisfaction with their health plans.
It addresses areas such as the ability to obtain information from
a health plan, the timeliness of services and the speed and accuracy
by which health plans process claims.
Rating
of Health Care
Rating
of Health Plan
Rating
of Personal Doctor
Rating
of Specialist Seen Most Often
Getting
Needed Care
Getting
Care Quickly
Doctor
Communications
Courteous/Helpful
Office Staff
Customer
Service
Claims
Processing
[Top]
Rating of Health
Care
Overall rating of your health care in the past 12 months - percent rating
health care 8, 9, or 10 on a scale of 0-10.
|
#1 in Michigan for 2006
#3 in United States
Top 10% in the Nation for 2006
|
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 77.24% |
79.78% |
86.30% |
87.7% |
78.02% |
88.00% |
|
[Top]
Rating of Health
Plan
Overall rating of Care Choices - percent rating Care Choices
8, 9, or 10 on a scale of 0-10. |
#1 in Michigan for 2006
#6 in United States
Top 10% in the Nation for 2006
|
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 67.50% |
74.47% |
81.46% |
80.9% |
65.21% |
81.50% |
|
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Rating of Personal Doctor
Overall rating of your personal doctor - percent rating
health care 8, 9, or 10 on a scale of 0-10.
|
#1 in Michigan for 2006
#12 in United States
Top 10% in the Nation for 2006
|
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 71.25% |
73.91% |
80.92% |
82.70% |
77.19% |
83.00% |
|
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Rating of Specialist
Seen Most Often
Overall rating of the specialist seen most often in the
past 12 months - percent rating health care 8, 9, or 10 on
a scale of 0-10. |
#1 in Michigan for 2006
#1 in United States
Top 10% in the Nation for 2006
|
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 76.85% |
81.74% |
88.55% |
90.1% |
78.13% |
90.2% |
|
[Top]
Getting Needed Care
Getting care believed to be necessary; getting referrals
to specialists; getting timely plan approvals when required.
(Percent rating this measure "not a problem"). |
#2 in Southeast Michigan for 2006*
|
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 77.94 % |
78.26% |
80.64% |
81.0% |
80.15% |
Not trendable |
|
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Getting Care Quickly
In-office wait time less than 15 minutes from appointment
time; getting appointment as soon as wanted for both routine
care and when needed right away for illness or injury; getting
help or advice when calling office during regular office hours.
(Percent rating for this measure includes responses of "usually" and "always"). |
#1 in Southeast Michigan for 2006*
|
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 83.51 % |
82.44% |
84.19% |
84.8% |
79.67% |
Not trendable |
|
[Top]
Doctor Communications
Listening carefully, showing respect for what member had
to say, understandable explanations, spending enough time with
the member. (Percent rating for this measure includes responses
of "usually" and "always"). |
#3 in Southeast Michigan for 2006*
|
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 92.42% |
91.40% |
93.04% |
92.4% |
92.15% |
92.7% |
|
[Top]
| Courteous/Helpful Office
Staff |
| Office staff as helpful as expected, and being
treated with courtesy and respect by office staff. (Percent
rating for this measure includes responses of "usually" and "always"). |
#1 in Michigan for 2006 |
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 93.14% |
93.37% |
92.45% |
93.2% |
93.23% |
N/A |
|
[Top]
Customer Service
Finding/understanding information, getting help needed,
problems filling out paper work. (Percent rating this measure "not
a problem"). |
#2 in Southeast Michigan for 2006*
|
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 72.64% |
69.10% |
77.35% |
74.8% |
71.17% |
Not trendable |
|
[Top]
Claims Processing
Claims handled in a reasonable time, claims handled correctly.
(Percent rating for this measure includes responses of "usually" and "always"). |
#1 in Southeast Michigan for 2006*
|
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 89.29% |
92.35% |
89.61% |
94.5% |
89.13% |
95.00% |
|
[Top]
The Health Employer and Data Information
Set (HEDIS)® Results
HEDIS is a set of standardized performance measures designed
to help consumers evaluate the quality of care and services provided
by their health plans.
Effectiveness of Care Rate Measures:
Childhood
Immunizations
Adolescent
Immunizations
Breast
Cancer Screening
Cervical
Cancer Screening
Medical
Assistance with Smoking Cessation
Chlamydia
Screening in Women
Controlling
High Blood Pressure
Beta
Blocker Treatment After Heart Attack
Comprehensive
Diabetes Care
Use
of Appropriate Medications for People with
Asthma
Follow-up
After Hospitalization for Mental Illness
Access/Availability of Care Rate Measures:
Prenatal
and Postpartum Care
Children's & Adolescents'
Access to Primary Care Providers
Use of Services Rate Measures:
Well
Child Visits in the 3rd-6th Year of Life
Well
Child Visits in First 15 Months of Life: 6+ visits
Adolescent
Well-Care Visit
[Top]
Childhood Immunizations
Percentage of members who turned two years old during the measurement
year who had the following vaccines during the time period specified
and by the child’s second birthday: four DTaP/DT, three IPV,
one MMR, three H influenza type B, three hepatitis B (Combined
1) plus one chicken pox vaccine (VZV) (Combined 2).
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| Combined 2 |
| 66.95% |
79.78% |
80.37% |
83.45% |
77.71% |
≥ 84% |
| Combined 3 (new measure in 2006) |
| N/A |
N/A |
N/A |
52.80% |
53.1% |
≥ 55% |
|
[Top]
Adolescent Immunizations
Percentage of members who turned 13 years old during the measurement
year, who had a second dose of MMR, three hepatitis B (Combined
1) plus one VZV (Combined 2) by the member’s 13th birthday.
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| Combined 2 |
| 40.15% |
48.91% |
67.88% |
68.89% |
53.70% |
≥ 70% |
|
[Top]
Breast Cancer Screening
Percentage of female members ages 50-69 who had a mammogram in
the past two years.
#1 in Southeast Michigan in 2006*
|
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 86.90% |
86.90% |
87.72% |
79.25% |
72.02% |
≥ 80 % |
|
[Top]
Cervical Cancer Screening
Percentage of female members ages 18-64 who received a Pap test
within the past three years.
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 87.07% |
86.73% |
83.57% |
85.15% |
81.81% |
≥ 85.5% |
|
[Top]
Medical Assistance with Smoking Cessation
Assess different aspects of providing medical assistance with smoking
cessation. These rates are based on member 18 years of age and
older who were either current smokers or recently quit smoking,
who were seen by a Care Choices practitioner during the past year:
- Advising Smokers to Quit
This measure shows the percentage of qualifying members who received advice
to quit smoking.
- Discussing Smoking Cessation Medications
This measure shows the percentage of qualifying members whose recommended
or discussed smoking cessation medications.
- Discussing Smoking Cessation Strategies
This measure shows the percentage of qualifying members whose practitioner
recommended or discussed smoking cessation methods or strategies.
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| Advising Smokers to Quit |
| 80.90% |
76.19% |
76.72% |
76.56% |
71.18% |
≥ 78.00% |
| Discussing Smoking Cessation Medications |
#1 in Michigan for 2006
Top 10% in the Nation for 2006 |
|
| 51.50% |
45.93% |
46.75% |
51.21% |
39.40% |
≥ 52.00% |
| Discussing Smoking Cessation Strategies |
#1 in Michigan for 2006
Top 10% in the Nation for 2006 |
|
| 39.00% |
36.19% |
43.10% |
50.72% |
38.95% |
≥ 51.50% |
|
[Top]
Chlamydia Screening in Women
Percentage of female members ages 16-26 (ages 16-25 for 2004 reporting
year) who were identified as sexually active and who had at least
one test for chlamydia during the past year.
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 28.06% |
34.60% |
33.82% |
37.29% |
34.91% |
≥ 40.00% |
|
[Top]
Controlling High Blood Pressure
Percentage of members ages 46-85 who had a diagnosis of hypertension
and whose blood pressure was adequately controlled (less than or
equal to 140/90).
Top 10% in the Nation in 2006.
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 59.21% |
64.07% |
66.05% |
76.82% |
68.82% |
≥ 79.00% |
|
[Top]
Beta Blocker Treatment After Heart
Attack
Percentage of members age 35 and older who experienced heart attacks
and were discharged with beta blocker prescriptions. Treatment with
beta blockers has been shown to lower the risk of subsequent heart
attacks.
Top 10% in the Nation in 2006.
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 96.90% |
97.56% |
99.25% |
100% |
96.63% |
100.00% |
|
[Top]
Comprehensive Diabetes Care
Percentage of members ages 18-75 with diabetes who had the specified
service or outcomes which address important aspects in the management
of diabetes: blood glucose levels (HbA1c), cholesterol levels (LDL-C),
kidney damage (nephropathy), and retinal disease (eye exam).
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| HbA1c
Testing |
| 91.32% |
89.54% |
91.24% |
91.24% |
87.53% |
≥ 92.00% |
Poor HbA1c Control
Note: Lower is better |
#1 in Southeast Michigan for 2006*
Top 10% in the Nation in 2006
|
|
| 15.00% |
20.92% |
19.95% |
19.95% |
29.68% |
< 20.00% |
|
|
| 58.16% |
55.23% |
56.20% |
57.21% |
54.79% |
≥ 58.00% |
| Cholesterol (LDL-C) Screening |
#1 in Southeast Michigan for 2006*
|
|
| 91.05% |
92.94% |
95.13% |
95.13% |
92.27% |
≥ 96.00% |
| Cholesterol Control (LDL-C <130
mg/dL) |
#1 in Michigan for 2006
Top 10% in the Nation in 2006
|
|
| 63.16% |
75.43% |
81.51% |
81.51% |
67.51% |
≥ 78.00% |
| Monitoring for Diabetic Nephropathy |
#1 in Southeast Michigan for 2006*
Top 10% in the Nation in 2006
|
|
| 72.37% |
63.02% |
67.15% |
73.35% |
55.10% |
≥ 75.00% |
|
[Top]
Use of Appropriate Medications for People
with Asthma
Percentage of members 5-56 years of age with persistent asthma who
were appropriately prescribed medication during the past year. This
measure evaluates if members with persistent asthma are prescribed
medications that are acceptable as primary therapy for long-term
asthma control.
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| Combined Rate (Ages 5-56) |
Top 10% in the nation in 2006 |
|
| 77.72% |
76.10% |
78.21% |
95.10% |
89.87% |
≥ 96% |
|
|
| 85.02% |
77.92% |
80.44% |
95.71% |
95.65% |
≥ 96% |
| Ages 10-17 |
Top 10% in the nation in 2006 |
|
| 71.82% |
72.21% |
72.92% |
96.86% |
91.69% |
≥ 97% |
| Ages 18-56 |
#1 in Southeast Michigan*
Top 10% in the nation in 2006 |
|
| 78.11% |
76.89% |
79.25% |
94.59% |
88.50% |
≥ 95% |
|
[Top]
Follow-up After Hospitalization for Mental
Illness
Percentage of discharges for members 6 years of age and older who
were hospitalized for treatment of selected mental health disorders,
who were seen on an ambulatory basis or day/night mental health visit
within 7 and 30 days after discharge.
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| Within 7 Days |
| 71.48% |
66.07% |
67.46% |
68.75% |
55.80% |
≥ 70% |
| Within 30 Days |
| 81.34% |
75.00% |
80.16% |
77.88% |
75.89% |
≥ 80% |
|
[Top]
Prenatal & Postpartum Care
Prenatal Care in the First Trimester
Timeliness of Prenatal Care: Percentage of female members who received a prenatal
care visit within the first trimester or within 42 days of enrollment in the
health plan.
Postpartum Care: Percentage of female members who had a postpartum
visit on or between 21 and 56 days after delivery.
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| Timeliness of Prenatal Care |
| 86.49% |
92.68% |
93.01% |
93.89% |
91.84% |
≥ 94.00% |
| Postpartum Care |
| 73.31% |
83.84% |
84.28% |
84.72% |
81.46% |
≥ 85.00% |
|
[Top]
Children's & Adolescents'
Access to Primary Care Providers
Percentage of enrollees 12–24 months, 25 months–6 years,
7–11 years and 12–19 years of age who had a visit with
an MCO primary care practitioner.
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 12-24 Months |
| 97.36% |
97.16% |
96.90% |
96.63% |
96.98% |
≥ 97.5% |
| 25 Months - 6 Years |
| 85.13% |
87.00% |
87.79% |
89.03% |
89.33% |
≥ 91% |
| 7-11
Years |
| 88.51% |
88.53% |
88.52% |
89.77% |
88.60% |
≥ 91% |
|
|
| N/A |
87.48% |
87.73% |
88.04% |
86.10% |
≥ 90% |
|
[Top]
Well Child Visits in the 3rd-6th Year
of Life
Percentage of children, ages 3 to 6 years old who had a visit with
a Care Choices primary care practitioner during the past year.
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 61.97% |
62.51% |
65.21% |
63.30% |
65.60% |
≥ 65.5% |
|
[Top]
Well Child Visits
in First 15 Months of Life: 6+ visits
Percentage of enrolled members who turned 15 months old during the
measurement year, who were continuously enrolled in the MCO from
31 days of age and who received six or more well-child visits with
a primary care practitioner during their first 15 months of life.
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 6+ Visits |
| 68.39% |
69.88% |
69.88% |
71.93% |
71.07% |
≥ 73 % |
|
[Top]
Adolescent Well-Care
Visit
Percentage of enrolled members who were 12–21 years of
age and continuously enrolled during the measurement year and who
had at least one comprehensive well-care visit with a primary care
practitioner or an OB/GYN practitioner during the measurement year.
| Care Choices Performance |
2006
National Average |
Care Choices
2007 Goal |
| 2003 |
2004 |
2005 |
2006 |
| 35.10% |
46.23% |
46.23% |
38.24% |
38.76% |
> 46%
|
|
[Top]
* Of the plans serving the entire five-county metro area, including
Wayne, Oakland, Macomb, Washtenaw and Livingston counties.
AM Best Rating
 A.M.
Best Co. has again assigned a financial strength rating of B+ (Very
Good) to Care Choices HMO (Farmington Hills, MI). The rating outlook
continues to be stable.
According to A.M. Best Co., “The rating of Care Choices
HMO reflects the support of its parent, Trinity Health. Other
positive rating factors include Care Choices positive earnings,
adequate
stand-alone balance sheet strength, and strong commitment to
high quality of care outcomes for its members.”
In addition, “Care Choices continues to focus on profitable
customer segments and geographic markets that leverage its affiliation
with Trinity Health,” the rating company reported. They added, “As
a result, the health plan continues to generate earnings and
maintain adequate, stand-alone balance sheet strength for its
rating. Furthermore,
Care Choices demonstrated commitment to quality health care outcomes
for its members is a strategic differentiation from its competition
and a strong value proposition for its subscribers.”
A.M. Best Co., established in 1899, is the world’s oldest
and most authoritative insurance rating and information source.
For more information, visit A.M. Best’s website at www.ambest.com.
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