We base our quality ratings on clinical quality data and patient experience. Our model of quality represents features highlighted by member feedback and those physicians define as “best practice” for quality of care.
Our policy on measuring and reporting provider performance guides the selection of quality measures. Key points in the policy include:
- Use established standards when available. If standards do not exist, develop measures using criteria such as clinical importance and scientific acceptability.
- Data must be valid and reliable. For each measure, providers are included if they meet a minimum number of population-based measures or sample size requirements.
- Providers receive the results before releasing them publicly.
Quality Ratings Display
We rate quality on a scale of one to four stars, with four stars indicating highest performance. You can compare providers and evaluate medical groups and hospitals at three levels:
- Overall quality rating, represented by one to four stars. An overall quality rating is provided for primary care medical groups and hospitals, but not for specialties.
- Quality ratings for each quality domain, also represented by one to four stars. Domains are sub-groupings of quality.
- Actual results for individual quality measures, such as optimal diabetes care or care for back pain.
Measuring patient experience
We regularly survey our members to learn about their experiences as patients. Our surveys use randomly selected samples. Examples include a survey about the clinic a member uses for routine care, a survey of members who were hospital patients and those who received specialty care. We share summary results with clinics and hospitals for use in quality improvement. We also provide tools and support to assist clinics and hospitals in improving quality.
Measuring clinical quality
We typically assess clinical quality by checking medical records for evidence of care and treatment or by checking medical billing data for similar information.
We collect data from across our regional network and reputable third-party sources, such as Minnesota Community Measurement, that collect, analyze and publicly report the results. We review standards established by organizations such as the National Quality Forum and the Institute for Clinical Systems Improvement.
We represent values for patient experience with measures for getting care and information along with care and communication. Data for staying healthy and care for illness or chronic conditions represent clinical quality. Health information technology and generic prescribing measure health information technology capabilities to improve safety and experience, measures of medication safety, and use of safe and effective generic drugs.
Our quality ratings for specialties include cardiology ear, nose and throat; obstetrics and gynecology; and orthopaedics. We group these ratings into the following quality domains:
- Receiving care: measures access to care, such as time in the waiting room and appointment scheduling.
- Care and communication: measures physician/staff communication and patient satisfaction with quality of care.
- Generic prescribing: measures medication safety, and use of safe effective generic drugs.
- Heart care and OB/GYN care: cardiology and OB/GYN only.
We group 45 quality measures for hospital ratings into the following quality domains:
- Patient experience: looks at patient perspectives on care and communication with their clinic and doctor.
- Helping patients get better: measures care delivered supporting heart care, pneumonia, hospital acquired infections and other care needs.