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Independence members rate their physician experience

October 3, 2016

Independence uses composite scores related to interactions between our members and their physicians to evaluate the experience between the two. Information for commercial and Medicare Advantage members is taken from the Consumer Assessment of Healthcare Providers and Systems (CAHPS® ). Information for members enrolled in a Health Insurance Marketplace (Marketplace) plan is taken from the Qualified Health Plan Enrollee Experience Survey (QHP® EES). Using these surveys, 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.

Note: Even though the composite indicators are the same, scores are measured based on questions and measures unique to commercial, Medicare Advantage, and Marketplace plans.

Commercial plans

CAHPS scoring for commercial plans is measured according to the percentage of members who answered ?Always/Usually? in regard to the following indicators:

  • 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
IndicatorKeystone Health Plan East (KHPE)Personal Choice®
Getting Care Quickly86%88%
Getting Needed Care89%88%
Coordination of Care82%86%
How Well Doctors Communicate95%97%

Medicare Advantage plans

CAHPS scoring for Medicare Advantage plans is measured according to the percentage of members who answered ?Always? in regard to the following indicators:

  • 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; and 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 is willing to listen to any questions or concerns, and spends enough time with the member.
Member Satisfaction CAHPS ? Medicare Advantage plans
IndicatorKeystone 65 HMOPersonal Choice 65SM PPO
Getting Care Quickly56%59%
Getting Needed Care64%64%
Coordination of Care71%75%
How Well Doctors Communicate81%83%

Marketplace plans

QHP EES scoring for Marketplace plans is measured according to the percentage of members with positive answers with relation to the following indicators:

  • 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. 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; and 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 QHP EES ? Marketplace plans
IndicatorKHPEPersonal Choice
Getting Care Quickly74%78%
Getting Needed Care76%78%
Coordination of Care85%82%
How Well Doctors Communicate91%89%

Results

When comparing Independence results versus national results, the experience for KHPE members reports between the 50th and 90th percentiles, with How Well Doctors Communicate reaching the goal of the 90th percentile. Overall evaluation of member satisfaction reports via CAHPS for KHPE members shows an improvement in all indicators, with the exception of Getting Care Quickly, which remained unchanged from 2015.

The rates for Personal Choice members report between the 50th and 90th percentiles for positive outcomes, with How Well Doctors Communicate also reaching the goal of the 90th percentile. CAHPS rates for Personal Choice members improved for Getting Care Quickly and How Well Doctors Communicate, but declined for Getting Needed Care and Coordination of Care.

For both Keystone 65 HMO and Personal Choice 65 PPO, member experience reports at or above the Centers for Medicare & Medicaid Services (CMS) National Distribution for positive outcomes. This is unchanged from 2015.

Composite rates for QHP EES report within the National Distribution for both KHPE and Personal Choice Marketplace plans.* Our goal is to reach the 90th percentile or a 5 STAR rating in the applicable measurement systems while demonstrating continuous scoring improvement on a year-to-year basis.

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:

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

Additional information is available online 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 2016 results. Rates reported for Medicare Advantage are from data collected via Morpace, and may be slightly different than actual CMS reporting.

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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