Consumer Guide to Health Care
Health Care and Quality
Health plan quality |
Hospital quality |
Nursing home quality |
Doctor quality |
Medical lab quality
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Does the quality of health care vary?
Yes, some health plans and doctors simply do a
better job than others of helping you stay healthy and
getting you better if you are ill. The choices you
make—about health plans, doctors, hospitals, or
nursing homes—can influence the quality of care you
How can you tell which choices offer
high-quality health care and which do not?
Fortunately, more and more groups are working on ways to
measure, report on, and improve the quality of health
care. Keep checking for new information to help you make
choices to improve the quality of your own care.
What is high-quality health care and how is it
High-quality health care means doing the right thing, at
the right time, in the right way, for the right
person—and having the best possible results. There are
two main types of information that can help you choose
high-quality health care:
- Consumer ratings: These look at health care
from the consumer's point of view. For example, do
doctors in a health care plan communicate well?
- Clinical performance/technical measures:
These measures look at how well a health care
organization prevents and treats illness. For
example, do children get the immunizations (shots)
they need when they need them?
Where can I find information on the quality of health care?
Reports on quality go by different names, including
performance reports and report cards. Reports on quality
don't tell you which health care choices are the best.
They can help you decide which are best for you,
based on the things that are most important to you. Here
are some reports on the quality of health care in
Quality and health plans
NCQA Health Choices displays
Health Plan Report Cards compiled by the National
Committee on Quality Assurance (NCQA). NCQA is a
private nonprofit organization that accredits health
plans. Accreditation is a "seal of
approval." To earn accreditation, organizations
must meet national standards, often including
clinical performance measures. Organizations choose
whether to participate in accreditation programs.
Accreditation is not a guarantee of the quality of
care that any individual patient will receive or
that any individual physician or other provider
Medicare Plan Finder from the federal Centers for Medicare and Medicaid Services
(CMS) provides recent consumer ratings and clinical
performance measures for all Medicare managed care
Wisconsin BadgerCare Plus HMO Choice Booklet (includes BadgerCare Plus Report Card)
(PDF, 292 KB)
compares HMOs that serve Wisconsin BadgerCare Plus members in nine areas of health care and four areas
of member satisfaction.
Plan Report Card (PDF, 3.5 MB) is published by the
Department of Employee Trust Funds for state employees. The report card
includes consumer ratings and technical measures.
- The Performance and Progress
Report from the Wisconsin Collaborative for
Healthcare Quality includes information on quality for a variety of Wisconsin
Quality and hospitals
Compare, from CMS, allows you to check on the quality of
care provided for conditions like heart attack, heart failure and
pneumonia at hospitals throughout the country.
from the Wisconsin Hospital Association, provides some
information on the quality of care provided by many
Wisconsin hospitals. The site includes measures of how
well hospitals performed when caring for patients with
heart attacks, heart failure, and pneumonia as well as
information on what hospitals are doing to prevent
Leapfrog Group Hospital Survey: Reports from hospitals on progress they have
made toward meeting
safety standards established by The
Leapfrog Group, a coalition of public and
private organizations that purchase health care
benefits for their employees.
The Performance and Progress Report from the
Wisconsin Collaborative for Healthcare
Quality includes information on quality for many Wisconsin hospitals.
Quality and nursing homes
Home Compare, from the federal Centers for
Medicare & Medicaid Services, provides clinical
performance measures and results of state
inspections for all Medicare and Medicaid certified
Quality and doctors/clinics
Quality and medical labs
You Identify Quality Laboratory Services (PDF, 39 KB).
Although you can’t always choose the lab
where your tests are processed, this checklist from
the Joint Commission can help you judge the quality
of the lab your clinic or physician uses. The Joint
Commission is a nonprofit organization that evaluates health care
quality and safety.
- Quality Check is a service
offered by the Joint Commission that lets you look
up medical laboratories by name or location.
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March 15, 2013