AmeriHealth uses composite scores from the Consumer Assessment of Healthcare
Providers and Systems (CAHPS®) related to interactions between
our members and their physicians to evaluate the experience between the two.
These composite scores are calculated by the National Committee for Quality
Assurance (NCQA) designated vendor, Morpace Marketing Research and Consulting,
and presented to AmeriHealth once the results are complete. Even though the
composite indicators are the same, scores are measured based on questions and
measures unique to commercial and Medicare Advantage plans.
Commercial plans
CAHPS scoring for commercial plans is measured according to the percentage
of members who answered ?Always/Usually? in regards to the following:
- Getting Care Quickly. The member is able to get care and
appointments as soon as needed.
- Getting Needed Care. The member is able to have an easy
time obtaining the care he or she believes is necessary and to schedule an
appointment with a specialist.
- Coordination of Care. In the last 12 months, the member?s
personal physician has been kept informed and up to date about the care he or
she has received from specialists or other health care providers.
- How Well Doctors Communicate. The physician shows the
member respect by explaining the information in a way the member understands,
is willing to listen to any questions or concerns, and spends enough time with
the member.
Member Satisfaction CAHPS ?
commercial plans
| Indicator | AmeriHealth
Pennsylvania | AmeriHealth New Jersey |
|---|
| | HMO | POS | PPO |
|---|
| Getting Care Quickly | 86.74% | 86.24% | 84.96% | 91.82% |
| Getting Needed Care | 89.35% | 88.80% | 88.36% | 91.32% |
| Coordination of Care | 81.38% | 76.79% | 80.13% | 81.74% |
| How Well Doctors Communicate | 95.43% | 93.60% | 95.06% | 96.09% |
Medicare Advantage plans
CAHPS scoring for AmeriHealth 65 Preferred HMO is measured according to the
percentage of members who answered ?Always? in regards to the following:
- Getting Care Quickly. The member receives care as soon as
it is needed (urgent), obtains an appointment as soon as one is needed
(routine), and sees a physician within 15 minutes of the scheduled appointment
time.
- Getting Needed Care. The member is able to have an easy
time obtaining the care and tests he or she believes are necessary and to
schedule an appointment with a specialist.
- Coordination of Care. The physician was in possession of
member medical records; the member had tests performed when determined it was
necessary, and the physician followed up with test results; discussions were
held regarding prescription medications; the member received assistance in
managing his or her care; the physician was kept informed and up to date about
care the member has received from specialists or other health care providers.
- How Well Doctors Communicate. The physician shows the
member respect by explaining the information in a way the member understands,
is willing to listen to any questions or concerns, and spends enough time with
the member.
Member Satisfaction CAHPS ?
Medicare Advantage plans
| Indicator | AmeriHealth
65 Preferred HMO |
|---|
| Getting Care Quickly | 52.4% |
| Getting Needed Care | 61.4% |
| Coordination of Care | 69.1% |
| How Well Doctors Communicate | 76.0% |
Results
When comparing AmeriHealth results versus national results, the experience
for commercial HMO and POS members falls at or below the 50th percentile, while
commercial PPO ranges between the 50th and 90th percentiles for positive
outcomes. One key indicator is Getting Care Quickly. This indicator for HMO and
POS plans fell within or below the 25th percentile while for PPO it fell within
the 95th percentile. For AmeriHealth 65 Preferred HMO, member experience falls
below the Centers for Medicare & Medicaid Services (CMS) National Distribution
for positive outcomes.* Our goal is to reach the 90th percentile for all
commercial measures and to continue to improve on the Medicare Advantage
measures in order to exceed CMS National Distribution and achieve a 5 STAR
rating.
Resources available to you
AmeriHealth values our network practitioners and the work involved in
maintaining quality care. We offer a range of services and opportunities to
help you maintain and improve care, including, but not limited to:
- Network Coordinators/Provider Partnership Associates
- Care Management Services, including Complex Case Management and Condition
Management (including Maternity Management)
- Behavioral Health Care services
- Pharmacy services
Additional information is available in the Resources for Patient Management section of our website or
in the Administrative Tools & Resources section of the NaviNet®
web portal. Note: Similar information will be available for AmeriHealth New Jersey in the near future.
* Plan comparison is reported
via the NCQA Quality Compass tool and CMS National Distribution 2014 results,
as 2015 results have not yet been published.
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