Maryland Performance Report on HMOs and POS Plans 2007-2008
Measure Type: Process, Patient, Satisfaction
The Maryland Health Care Commission provides accessible information to the public on the cost and quality of health care. They look at hospitals, health insurances, assisted living, long-term care, nursing homes, prescription drugs, and HMO’s (health plans). Data is mainly received from the Health Services Cost Review Commission (HSCRC), the Department of Health and Mental Hygiene (DHMH), along with other various resources such as the Department on Aging (used for the nursing home guide).
There are 18 measures used for testing the quality of care of these hospitals. They illustrate data on heart attacks (AMI), heart failure (CHF), pneumonia, and surgical care improvement (on hip, knee, and colon surgeries). It consists of raw data displaying process measures that are updated biennially.
The Maryland Health Care Commission also allows consumers to view all the acute care hospitals in Maryland. Information on the number of cases, the average charge per case, and the average charge per day are listed. The charges listed do not include physician professional fees. Mortality rates are not used in the data collection from Maryland’s Hospital Guide. They are developing a computer program where it would adjust the death rate of various patients admitted to a hospital.
Information on health insurances do not provide data sets on the best insurance to choose from, or the average charge consumers would have to pay for a particular insurance plan. It does, however, present articles and power point slides comparing various insurance types. For example, looking at the ‘Health Insurance Coverage’- 2005 report, comparisons are made on Medicaid, the amount of individuals Uninsured, Direct-Purchases (private insurances), along with Other Public (Medicare and military-related coverage).
Maryland’s Assisted Living Guide provides information on more than 300 assisted living facilities. They offer a home and support service for individuals who need help in conducting various tasks such as managing medication. Only facilities with 10 beds or more were used for their data intake. They also offer suggestions and actions to take if you have a complaint about a facility. Information on the cost of stay is provided, along with comparisons among facilities based on the type of services they offer (personal care, hospice service, transportation services, etc).
Maryland’s General Assembly has passed the Long-Term Care Planning Act of 2006 for the state to conduct reports on long-term services and programs for individuals 65 years and older. Charts are listed in the report illustrating the increase of community residents in the next twenty years. Some topics include: population by ‘age group’, ‘actual and projected non-institutionalized residents with physical, self-care, or going-outside-the-home-disability’.
Maryland’s nursing home guide notifies consumers of information on the facilities best suitable for patients. The nursing homes are compared based on four categories. They evaluate facilities characteristics, resident characteristics, quality measures, and quality indicators (QI’s). There are 14 quality measures that are reported from the Centers for Medicaid and Medicare Services (CMS). Data is updated periodically since they have several data sources (e.g. CMS/Maryland Long Term Care Survey).
At the Maryland Health Care Commission site, they offer a link to Maryland’s Attorney General website, which provides a ‘Prescription Drug Finder’ for consumers. Prices for the 26 most commonly used drugs are reported from the State’s Medical Assistance Program. Explanations are listed for these drugs, reporting what type of treatments they are used for. Once a county is selected the consumer may select the desired medication. The address, store, and cost are provided for each county, making it consumer-friendly to determine the average price for a prescription. This is particularly helpful for the elderly population who may not be well informed as to the ‘ballpark’ figures of the cost for their prescribed medication.
HMO (Health Plans)
Maryland’s Health Care Commission also conducts an annual performance report on the quality of commercial health maintenance organizations (HMO’s). The Consumer Assessment of Healthcare Providers and Systems (CAHPS) collected information on the experience individuals have on their health plan. To report clinical health care information, the Healthcare Effectiveness Data and Information Set (HEDIS) were utilized. The performance report provides information on member satisfaction, adult’s preventative care, children’s health, chronic care, diabetes care, and behavioral health care. Data is compared nationally.