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NCQA Health Insurance Plan Ratings 2017-2018 - Detail Report (Private)


Plan Name:   Group Health Cooperative of South Central Wisconsin Rating: 4.5
URL: www.ghcscw.com
States: WI NCQA Accreditation:   Yes
Other Names: Group Health Cooperative of South Central Wisconsi
Lower Performance Higher Performance
≤1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0
 
  Plan Details Score
Add Consumer Satisfaction
3.5
  
Getting care
3.0
Getting care easily
Did members get appointments, preventive care, tests, and treatment easily?
2.0
Getting care quickly
Did members get appointments, preventive care, tests, and treatments promptly?
4.0
Satisfaction with physicians
3.0
Rating of primary-care doctor
Did members rate their primary-care doctors high overall?
3.0
Rating of specialists
Did members rate specialists high overall?
3.0
Rating of care
Did members rate their care high overall?
4.0
Coordination of care
Were members satisfied with how their primary provider coordinated care with other providers?
4.0
Health promotion and education
Were members informed of health promotion and illness prevention activities?
2.0
Satisfaction with health plan services
4.5
Handling claims
Were members satisfied with how their claims were handled?
5.0
Rating of health plan
Did members rate their overall plan services high?
4.0
 
Add Prevention
4.5
  
Children and adolescents
4.0
Well-child visits, infants
Did children age 15 months get up to six well-child visits since birth?
5.0
Well-child visits, ages 3-6
Did children ages 3 to 6 have at least one well-child visit in the latest year reported?
4.0
Adolescent well-care visits
Did members ages 12 to 21 have at least one comprehensive well-care visit in the latest year reported?
4.0
Childhood immunizations status- combination 10
Did children receive recommended immunizations by age 2?
5.0
Adolescent immunizations
Did children receive recommended immunizations by age 13?
3.0
BMI percentile assessment
Did members ages 3 to 17 have their BMI assessed?
4.0
Women’s reproductive health
5.0
Prenatal checkups
Did pregnant women have a prenatal visit in their first trimester or shortly after enrolling in a health insurance plan?
5.0
Postpartum care
Did women who gave birth have a postpartum visit three to eight weeks after delivery?
5.0
Cancer screening
5.0
Breast cancer screening
Did women ages 50 to 74 get mammograms every two years?
4.0
Colorectal cancer screening
Were members ages 50 to 75 screened for colorectal cancer?
5.0
Cervical cancer screening
Did women ages 21 to 64 receive cervical cancer screening?
5.0
Non-recommended cervical cancer screening in adolescent females
Were adolescent females ages 16 to 20 screened unnecessarily for cervical cancer?
5.0
Other preventive services
Adult BMI assessment
Did adult members ages 18 to 74 have their BMI assessed?
4.0
Chlamydia screening
Did sexually active women ages 16 to 24 get tested for chlamydia?
3.0
Flu shots for adults
Were members ages 18 to 64 vaccinated against the flu?
5.0
 
Add Treatment
4.5
  
Asthma
4.0
Asthma drug management
Did asthmatic members ages 5 to 85 take medication to control asthma as prescribed?
3.0
Asthma control
Did people ages 5 to 85 with persistent asthma have their symptoms well controlled during the year?
5.0
Diabetes
4.5
Blood pressure control (140/90)
Did diabetic members ages 18 to 75 have their blood pressure below 140/90 at their last visit?
5.0
Eye exams
Did diabetic members ages 18 to 75 have a retinal or dilated eye exam?
4.0
Glucose control
Did diabetic members ages 18 to 75 maintain their blood sugar level below 8 percent?
4.0
Patients with diabetes – received statin therapy
Did members ages 40 to 75 with diabetes who do not have cardiovascular disease receive a statin medication?
5.0
Patients with diabetes – statin adherence 80%
Did members ages 40 to 75 with diabetes who do not have cardiovascular disease stay on statin therapy as prescribed?
5.0
Heart disease
4.5
Beta blocker after heart attack
Did heart-attack patients 18 or older receive beta blockers for at least six months?
5.0
Controlling high blood pressure
Did hypertensive patients ages 18 to 85 have their blood pressure controlled (i.e., for patients 18 to 59 a BP <140/90 mm Hg, for patients 60 to 85 with a diagnosis of diabetes a BP <140/90 mm Hg or a BP <150/90 mm Hg without a diagnosis of diabetes)?
5.0
Patients with cardiovascular disease – received statin therapy
Did males 21 to 75 and females 40 to 75 with cardiovascular disease receive a high or moderate-intensity statin medication?
5.0
Patients with cardiovascular disease – statin adherence 80%
Did males 21 to 75 and females 40 to 75 with cardiovascular disease stay on high or moderate-intensity statin therapy as prescribed?
3.0
Mental and behavioral health
4.5
Depression: Adhering to medication for 12 weeks
Did adult members with a new episode of depression take a prescribed drug for at least 12 weeks?
5.0
Follow-up after hospitalization for mental illness
Were members hospitalized with a mental illness aged six and older followed up within a week of their discharge and again within a month?
5.0
Alcohol or drug dependence treatment initiated
Did alcohol- or drug-dependent members 13 and older receive inpatient or outpatient care?
4.0
Follow-up after ADHD diagnosis
Did children ages 6 to 12 who were newly prescribed ADHD medication have a follow-up visit within 30 days?
5.0
Cholesterol and blood sugar testing for youth on antipsychotic medications
Did members ages 1 to 17 who were on two or more antipsychotic medications have their blood sugar and cholesterol tested?
3.0
First-line psychosocial care for youth on antipsychotic medications
Did members ages 1 to 17 who had a new prescription for an antipsychotic medication have documentation of psychosocial care as first-line treatment?
NA
Other treatment measures
Observed-to-expected hospital readmissions
For members ages 18-64, how many hospital stays were followed by an unplanned hospital readmission within 30 days after discharge?
3.0
Appropriate antibiotic use, adults with acute bronchitis
Were adults ages 18 to 64 with acute bronchitis not prescribed antibiotics in the 3 days after their diagnosis, as recommended?
5.0
Appropriate testing and care, children with sore throat
Were children ages 3 to 18 with a sore throat given strep tests and appropriately prescribed antibiotics?
5.0
Steroid after hospitalization for acute COPD
Did members 40 and older who were hospitalized or had an ED visit for chronic obstructive pulmonary disease receive systemic corticosteroids within 14 days of discharge?
NA
Bronchodilator after hospitalization for acute COPD
Did members 40 and older who were hospitalized or had an ED visit for chronic obstructive pulmonary disease receive a bronchodilator within 30 days of their discharge?
NA
Appropriate antibiotic use, children with colds
Were children ages 3 months to 18 years with colds not prescribed antibiotics up to three days after their diagnosis, as recommended?
5.0
Appropriate use of imaging studies for low back pain
Were imaging tests appropriately not recommended for patients with a new episode of low back pain?
5.0