Consumer Guide to Health Care - Health Plan Quality

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:

  1. Consumer ratings: These look at health care from the consumer's point of view. For example, do doctors in a plan communicate well? 
  2. 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 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 Wisconsin:

  • 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 delivers.
Last Revised: November 23, 2014