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Independence members rate their physician experience

October 1, 2015

Independence 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, an independent company, and presented to Independence 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 Keystone Health Plan East (KHPE) Personal Choice®
Getting Care Quickly 87.08%87.26%
Getting Needed Care 86.21%90.39%
Coordination of Care 78.29%86.22%
How Well Doctors Communicate 93.82%95.77%

Medicare Advantage plans

CAHPS scoring for Medicare Advantage plans 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 Keystone 65 HMOPersonal Choice 65SM PPO
Getting Care Quickly 59.2%54.5%
Getting Needed Care 68.6%66.8%
Coordination of Care 75.1%75.9%
How Well Doctors Communicate 81.9%83.4%

Results

When comparing Independence results versus national results, the experience for KHPE members falls at or below the 25th percentile, while Personal Choice members range between the 50th and 90th percentiles for positive outcomes. One key indicator is Coordination of Care. This indicator for KHPE fell within the 25th percentile while for Personal Choice it fell within the 90th percentile. For both Keystone 65 HMO and Personal Choice 65 PPO, member experience falls at or above 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

Independence 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
  • Care Management Services, including Complex Case Management and Condition Management (including Maternity Management)
  • Behavioral Health Care services
  • Pharmacy services

Additional information is available on our website in the Resources for Patient Management section or in the Administrative Tools & Resources section of the NaviNet® web portal.

* Plan comparison is reported via the NCQA Quality Compass tool and CMS National Distribution 2014 results, as 2015 results have not yet been published.

NaviNet is a registered trademark of NaviNet, Inc., an independent company.


This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
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Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.