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General
Why aren't there cost or quality ratings for all providers?
Providers with ratings represent over 70% of all episodes of care for HealthPartners members. HealthPartners assigns a cost or quality rating based on extensive data and analysis. Some providers do not have a sufficient number of HealthPartners patients to accurately assign a cost or quality score. Additional providers will be rated when the volume of data is sufficient.
Why aren't there cost and quality ratings for clinics across the country?
Ratings for cost and quality depend on the availability of data. In the Minnesota region we have a significant volume of claims data to rate our providers and facilities. Currently, there's no comprehensive national source for cost and quality information for primary and specialty care. National sources currently offer information only about hospitals. Additionally, this national source cost data is currently limited to billed charge data which does not take into consideration health plan negotiated discounts.
How often are ratings updated?
Most information is updated annually. Cost and quality ratings are based on the best information available to HealthPartners at the time of the analysis.
Cost
What is a cost rating?
Overall costs are assigned by analyzing the total cost of care for treating a condition, not just the fees for a particular service. The total cost of treating a condition includes lab tests, x-rays, care from additional physicians and hospital costs. The ratings show how effectively clinics and hospitals use resources for the unique group of patients they serve. This rating helps you compare the overall cost of care at one clinic or hospital to another.
What data is used to assign a cost rating to providers?
Cost is determined by using actual data submitted by providers that shows diagnosis and corresponding treatment. Providers are compared to those delivering similar types of care. Providers who are more efficient in diagnosing conditions, more efficient in treating those conditions and/or charge a lower fee for delivering care are lower cost compared to their peers.
Quality
How is quality defined?
HealthPartners' model of quality represents features of quality that members say they are interested in features that physicians have defined as "best practice" for quality of care. Patients are particularly interested in getting convenient appointments and good communication. Measures of clinic quality are based on medical standards defined by the Institute for Clinical Systems Improvement and organizations such as JCAHO, which accredits hospitals; Leapfrog, which monitors patient safety; and Quest Analytics, which analyzes hospital quality and safety.
In addition to the overall quality rating, what other information is available?
| Quality ratings - again designated with a relative standing of |
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- also are available for clusters of individual measures, ranging from patient experience to clinical quality to patient safety. Where possible, multiple measures are used for a cluster. The groupings are weighted and then combined to create an overall quality rating. Scores for specific measures can be viewed within each cluster. This allows members to focus on the features of quality that matter most to them. For specific measures, a higher score indicates better performance.
What data is used to assign a quality rating to providers?- For primary care, ratings are based on measures representing patient experience, preventive care, care for illness and chronic conditions, and patient safety. In some cases, a composite score is created from several individual measures. For example, the Diabetes measure (under Care for Chronic Conditions) consists of seven separate measures.
- Specialty care provider quality ratings draw from measures representing access to care, communication, preventive care, specialized care and patient safety. These measures are specific to each specialty.
- Hospital quality ratings include measures such as patient satisfaction, quality of care and patient safety.
How is patient experience measured?
HealthPartners regularly surveys our members to learn about their experiences as patients. These surveys are based on randomly selected samples and sound methods. Examples include a survey of members about the clinic they use for routine care, a survey of members who were hospital patients, and surveys of members who received specialty care. Results are shared with clinics and hospitals for use in quality improvement. HealthPartners provides tools and support to assist clinics and hospitals in improving quality.
How is clinical quality measured?
Clinical quality is typically assessed by checking medical records for evidence of care and treatment or by checking medical billing data for similar evidence. In some cases, members or patients responding to surveys indicate whether they received certain care, such as assistance to quit smoking.
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