This guide is designed to provide you with information about HMOs in Michigan. The Guide provides star ratings for the performance of Michigan HMOs. At the end of the ratings section of the guide is a link to help you find HMOs in your area. You will also find links to information about HMO enrollment, complaints, accreditation status, and financial reports.
The 2010 categories of information on the consumer guide are from the National Committee for Quality Assurance Accreditation® (NCQA®): Access & Service; Qualified Providers; Staying Healthy; Getting Better; and Living with Illness. Information used in parts of this report was compiled in conjunction with NCQA. The methodology used to calculate this information, is available by e-mailing OFIR at ofir-ins-info@michigan.gov.
The toll free number for the Michigan Office of Financial and Insurance Regulation is (877) 999-6442. If you are unable to print information from this site, or know someone who does not have access to this site, you can obtain the consumer guide information by calling OFIR toll free.
About the Star Ratings:
| |
*** |
Plan performance
is above average |
|
Symbols show statistically significant differences between
each HMO’s score. Statistically significant means scores varied by more
than could be accounted for by chance. The results were provided by
NCQA. |
| |
** |
Plan performance
is average |
|
| |
* |
Plan performance
is below average |
|
| |
NA |
Not available,
insufficient data |
|
|
| |
| 2010 RATING |
(derived from 2009 data)
Name of HMO |
Access and Service |
Qualified
Providers 1 |
Staying Healthy |
Getting
Better 2 |
Living with Illness 2 |
Blue Care Network of Michigan (E) |
* |
** |
* |
** |
* |
Grand Valley Health Plan, Inc. (E) |
** |
** |
*** |
** |
*** |
Health Alliance Plan of Michigan (E) |
* |
*** |
* |
** |
** |
HealthPlus of Michigan, Inc. (E) |
*** |
*** |
* |
** |
* |
Physicians Health Plan of Mid-Michigan (E) |
*** |
*** |
** |
* |
** |
Priority Health (E) |
** |
** |
*** |
** |
*** |
Total Health Care USA, Inc. (C) |
* |
* |
* |
** |
* |
| |
|
|
|
|
|
| 2009 RATING |
(derived from 2008 data)
Name of HMO |
Access and Service |
Qualified
Providers 1 |
Staying Healthy |
Getting
Better 2 |
Living with Illness 2 |
Blue Care Network of Michigan (E) |
* |
** |
* |
** |
* |
Grand Valley Health Plan, Inc. (E) |
*** |
** |
*** |
*** |
*** |
Health Alliance Plan of Michigan (E) |
** |
** |
* |
** |
* |
HealthPlus of Michigan, Inc. (E) |
*** |
*** |
** |
** |
** |
Physicians Health Plan of Mid-Michigan (E) |
*** |
*** |
*** |
* |
** |
Priority Health (E) |
*** |
*** |
*** |
** |
*** |
Total Health Care USA, Inc. (C) |
* |
* |
* |
** |
** |
| |
|
|
|
|
|
|
1 - For 2009 NCQA re-titled this measurement from Doctor Communication and Service
2 - For 2009 NCQA split former Getting Better/Living with Illness measurement into separate measurements
(E) Excellent accreditation
(C) Commendable accreditation
|
NCQA Accreditation evaluates aspects of HMOs. NCQA
conducts a comprehensive review of a health plan’s systems and structure.
NCQA accreditation applies to HMOs and is considered to be one measure of a
health plan's performance. The levels of NCQA accreditations are:
|
Excellent - The HMO demonstrates levels of service and clinical quality that meet or exceed NCQA’s requirements for consumer protection and quality improvement. HMOs earning this accreditation level must also achieve HEDIS results that are in the highest range of national or regional performance. |
|
Provisional - The HMO meets some of NCQA’s basic requirements for consumer protection and quality improvement. Denied - The HMO does not meet NCQA’s basic requirements for consumer protection and quality improvement. |
|
Not Accredited - This category includes HMO plans that have not sought accreditation from NCQA. |
|
Commendable - The HMO demonstrates levels of service and clinical quality that meet or exceed NCQA’s rigorous requirements for consumer protection and quality improvement.
|
|
Expired - Expired denotes an HMO that has allowed its provisional, one-year or full accreditation status to lapse without scheduling another accreditation survey. Plans receiving a denial do not revert to "expired".
|
|
|
|
Accredited - The HMO meets most of NCQA’s basic requirements for consumer protection and quality improvement.
|
|
Under Review by NCQA - NCQA designates Under Review to an HMO after NCQA has chosen to review the organization to assess the appropriateness of an existing accreditation status.
|
|
Link to the Michigan HMO Accreditation page on the OFIR website.
|
Performance Ratings HMOs in
Michigan are evaluated
on key quality measures relating to clinical care and member satisfaction.
Information presented in this report comes from health plan data systems and
member data gathered by Michigan HMOs as required by the state.
Access and Service Measures that capture
consumer experience with getting needed care, getting care quickly, health
plan customer service, and consumer overall rating of health plan.
Qualified Providers Measures that capture
consumer perceptions about how well their doctors communicate and the courteousness
and helpfulness of office staff. This category also includes overall ratings
of personal doctor, specialist seen most often and overall health care.
Staying Healthy Measures how often
preventive services are provided (e.g. immunizations, prenatal care,
mammography, and well-child visits).
Getting Better Measures how well
health plans help members recover from illness, such as, antibiotic overuse
and misuse, appropriate imaging for low back pain and whether physicians
advised smokers to quit.
Living with Illness Measures how well
health plans take care of people who have health problems, such as asthma,
diabetes, heart disease, mental illness, chronic obstructive pulmonary
disease (COPD) and rheumatoid arthritis.
| Additional HMO information |
HMOs In Your Area / HMO Enrollment / HMO
Complaint Information / HMO Financial Reports / HMO Accreditation Status /OFIR Home |
