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NCQA Health Insurance Plan Rankings 2014-2015 - Detail Report (Private)


       
Plan Name:   Harvard Pilgrim Health Care Ranked: 2
URL: www.harvardpilgrim.org Overall Score:   89.9
States: ME, MA NCQA Accreditation:   Yes
Health Plan Ranking Key
 
 
  Plan Details Score
Add Consumer Satisfaction
  
                Getting care
                 
                     Getting care easily
                     Did members get appointments, preventive care, tests, and treatment easily?
                     Getting care quickly
                     Did members get appointments, preventive care, tests, and treatments promptly?
                Satisfaction with physicians
                 
                     How well doctors communicate
                     Did members rate their doctors' communication skills high?
                     Rating personal doctor
                     Did members rate their primary-care doctors high overall?
                     Rating specialists
                     Did members rate specialists high overall?
                     Rating care received
                     Did members rate their care high overall?
                     Coordination of Care
                     Were members satisfied with how their primary provider coordinated care with other providers?
                     Health promotion and education
                     Were members informed of health promotion and illness prevention activities?
                     Shared decision making
                     Were members involved in their own care decisions?
                Satisfaction with health plan services
                 
                     Handling claims
                     Were members satisfied with how their claims were handled?
                     Rating health plan
                     Did members rate their overall plan services high?
 
Add Prevention
  
                Children and adolescents
                 
                     Well-child visits, infants
                     Did children age 15 months get up to six well-child visits since birth?
                     Well-child visits, ages 3-6
                     Did children ages 3 to 6 have at least one well-child visit in the latest year reported?á
                     Access for children ages 7-11
                     Did children ages 7 to 11 have at least one visit with a primary-care physician in the latest year reported?
                     Adolescent well-care visits
                     Did members ages 12 to 21 have at least one comprehensive well-care visit in the latest year reported?
                     Early immunizations
                     Did children receive all recommended immunizations by age 2?
                     Adolescent immunizations
                     Did children receive recommended immunizations by age 13?
                     BMI percentile assessment
                     Did members ages 3 to 17 have their BMI assessed?
                     Nutrition Counseling
                     Did children ages 3 to 17 receive nutrition counseling?
                     Physical activity counseling
                     Did children ages 3 to 17 receive counseling on physical activity?
                WomenÆs reproductive health
                 
                     Timeliness of prenatal checkups
                     Did pregnant women have a prenatal visit in their first trimester or shortly after enrollment?
                     Postpartum care
                     Did women who gave birth have a postpartum visit three to eight weeks after delivery?
                Cancer screening
                 
                     Breast cancer screening
                     Did women ages 50 to 74 get mammograms?
                     Colorectal cancer screening
                     Were members ages 50 to 75 screened for colorectal cancer?
                     Human Papillomavirus Vaccine
                     Did 13 year old female adolescent members receive the HPV vaccine?
                Other preventive services
                 
 
                     Adult BMI assessment
                     Did adult members have their BMI assessed?
                     Chlamydia screening
                     Were women ages 16 to 24 identifed as sexually active tested for chlamydia?
                     Flu vaccinations for Adults ages 18-64
                     Were members ages 18 to 64 vaccinated against the flu?
 
Add Treatment
  
                Asthma
                 
                     Medication Management for People with Asthma
                     Did asthmatic members ages 5 to 64 (Total) take their controller medication as prescribed?
                     Asthma Medication Ratio
                     Were persistent asthmatic members symptoms under control during the year?
                Diabetes
                 
                     Blood pressure control (140/80)
                     Did diabetic members ages 18 to 75 have their blood pressure below 140/80 at their last visit?
                     Blood pressure control (140/90)
                     Did diabetic members ages 18 to 75 have their blood pressure below 140/90 at their last visit?
                     Retinal eye exams
                     Did diabetic members ages 18 to 75 have a retinal or dilated eye exam?
                     Glucose testing
                     Did diabetic members ages 18 to 75 have their blood sugar level checked?
                     Glucose control
                     Did diabetic members ages 18 to 75 maintain their blood sugar level below 8 percent?
                     LDL cholesterol screening
                     Did diabetic members ages 18 to 75 have their LDL cholesterol level checked?
                     LDL cholesterol control
                     Did diabetic members ages 18 to 75 maintain their LDL cholesterol below 100 milligrams per deciliter?
                     Monitoring kidney disease
                     Did diabetic members ages 18 to 75 have their kidney function checked or monitored?
                Heart disease
                 
                     Beta blocker after heart attack
                     Did heart-attack patients 18 or older receive beta blockers for at least six months?
                     Controlling high blood pressure
                     Did hypertensive patients ages 18 to 85 have their blood pressure below 140/90 at their last visit?
                     LDL cholesterol screening
                     Did members ages 18 to 75 with heart disease have their LDL cholesterol level checked?
                     LDL cholesterol control
                     Did members ages 18 to 75 with heart disease keep their LDL cholesterol below 100 milligrams per deciliter?
                Mental and behavioral health
                 
                     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?
                     Depression--adhering to medication for six months
                     Did adult members with a new episode of depression take a prescribed drug for at least 6 months?
                     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?
                     Alcohol or drug dependence treatment initiated
                     Did alcohol- or drug-dependent members 13 and older receive inpatient or outpatient care?
                     Alcohol or drug dependence treated for 30 days
                     Did alcohol- or drug-dependent members 13 and older receive two or more services within 30 days after initial treatment?
                     Follow-up after ADHD diagnosis
                     Did children ages 6 to 12 who were newly prescribed ADHD medication have three follow-up visits within 30 days?
                     Continued follow-up after ADHD diagnosis
                     Did children ages 6 to 12 who were newly prescribed ADHD medication have three follow-up visits within 10 months?
                Other treatment measures
                 
 
                     Use of aspirin
                     Are adults at risk for cardiovascular disease currently taking aspirin?
                     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?
                     Appropriate testing and care, children with pharyngitis
                     Were children with a sore throat given strep tests and appropriately prescribed antibiotics?
                     Medication for rheumatoid arthritis
                     Did adult members ages 18 and older diagnosed with rheumatoid arthritis get the right drug?
                     Monitoring key long-term medications
                     Were adults with six-month prescriptions for certain drugs monitored appropriately?
                     Steroid after hospitalization for acute COPD
                     Did members who were hospitalized for chronic obstructive pulmonary disease receive systemic corticosteroids within 14 days of discharge?á
                     Bronchodilator after hospitalization for acute COPD
                     Did members 40 and older who were hospitalized for chronic obstructive pulmonary disease receive a bronchodilator within 30 days of their discharge?
                     Testing for COPD
                     Did members 40 and older have a spirometry test to confirm chronic obstructive pulmonary disease?
                     Appropriate antibiotic use, children with URI
                     Were antibiotics not prescribed to children with colds up to three days after their diagnosis, as recommended?
                     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?