Consumer Guide to Health Care
Health Plan Quality
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Does the quality of health plans vary?
Yes, some health plans simply do a better job than others of
helping you stay healthy and getting you better if you are ill. The
choices that you make about health plans can influence the quality
of care you get.
But 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 measured?
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 a high-quality health plan:
- Consumer ratings:
These look at health care from the consumer's point of view. For
example, do doctors in a plan communicate well?
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
Where can I find information on the quality of health plans?
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. But 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 plans in
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Health plan report cards
compiled by the National Committee on Quality
Assurance (NCQA) are updated the 15th of every month. 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
March 27, 2013