return to summary results
  

NCQA Health Insurance Plan Ratings 2018-2019 - Detail Report (Medicare)


Plan Name:   Fallon Community Health Plan Rating: 4.0
URL: www.fallonhealth.org CMS Contract: H9001
States: MA NCQA Accreditation:   Yes
Special Project: CMS Special Area None
Other Names: Medicare Advantage
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
4.0
  
Getting care
3.0
Getting care easily
Did members get appointments, preventive care, tests, and treatment easily?
3.0
Getting care quickly
Did members get appointments, preventive care, tests, and treatments promptly?
3.0
Satisfaction with physicians
4.5
Rating of primary-care doctor
Did members rate their primary-care doctors high overall?
4.0
Rating of specialists
Did members rate specialists high overall?
5.0
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
Satisfaction with health plan services
Rating of health plan
Did members rate their overall plan services high?
4.0
 
Add Prevention
4.0
  
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?
4.0
Flu shots
Were members vaccinated against the flu?
4.0
Pneumonia shots
Did members get vaccinated against pneumonia?
4.0
 
Add Treatment
3.5
  
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?
4.0
Eye exams
Did diabetic members ages 18 to 75 have a retinal or dilated eye exam?
5.0
Glucose control
Did diabetic members ages 18 to 75 maintain their blood sugar level below 8 percent?
5.0
Patients with diabetes – received statin therapy
Did members ages 40 to 75 with diabetes who do not have cardiovascular disease receive a statin medication?
4.0
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?
3.0
Heart disease
4.0
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?
4.0
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
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)?
4.0
Smoking advice
Were members advised by a practitioner to stop?
5.0
Mental and behavioral health
4.0
Depression: Adhering to medication for 6 months
Did adult members with a new episode of depression take a prescribed antidepressant drug for at least 6 months?
4.0
Follow-up after hospitalization for mental illness
Were members hospitalized with a mental illness followed up within a week after discharge?
5.0
Alcohol or drug abuse or dependence treatment engaged
Did alcohol- or drug-dependent members 13 and older receive two or more inpatient or outpatient care services within 34 days?
3.0
Other treatment measures
Observed-to-expected hospital readmissions
For members 65 years and older, how many hospital stays were followed by an unplanned hospital readmission within 30 days after discharge?
1.0
Managing risk of falls
Were members who fell or had problems with balance or walking seen by a practitioner and receive intervention to lower their risk?
4.0
Avoiding harmful drug and disease interactions
Were members not prescribed drugs considered potentially harmful because of their disease or condition?
2.0
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?
4.0
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?
3.0
Testing for osteoporosis
Did women 65 to 85 receive bone-density testing?
5.0
Managing osteoporosis in women after fracture
Did women 67 to 85 with a fracture get a bone mineral density test or appropriate drugs in next six months?
3.0
Avoiding high-risk medications
Were high-risk drugs avoided for older adults 66 years and older?
2.0
Non-recommended prostate cancer screening in older men
Were males 70 years old and older screened unnecessarily for prostate cancer using prostate-specific antigen based screening?
3.0