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This guide is designed to provide you with information about commercial
Health Maintenance Organizations (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 2012 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.
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About
the Star Ratings:
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*** |
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 |
|
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* |
Plan performance is below
average |
|
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NA |
Not available, insufficient
data |
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| 2012
RATING |
(derived
from 2011 data)
Name of HMO
|
Access and Service
|
Qualified
Providers |
Staying Healthy |
Getting
Better |
Living with
Illness |
|
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 (E) |
*** |
** |
** |
* |
** |
|
Priority Health (E) |
** |
*** |
*** |
** |
** |
|
Total Health Care USA, Inc. (C) |
* |
* |
* |
** |
** |
| |
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| 2011
RATING |
(derived
from 2010 data)
Name of HMO
|
Access and Service
|
Qualified
Providers |
Staying Healthy |
Getting
Better |
Living with
Illness |
|
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 (E) |
*** |
** |
** |
** |
** |
|
Priority Health (E) |
** |
*** |
*** |
** |
*** |
|
Total Health Care USA, Inc. (C) |
* |
* |
** |
** |
* |
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(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:
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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. |
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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. |
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Not
Accredited - This category includes HMO plans that
have not sought accreditation from NCQA. |
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Commendable
- The HMO demonstrates levels of service and clinical quality that
meet or exceed NCQA's rigorous requirements for consumer protection
and quality improvement.
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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".
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Accredited
- The HMO meets most of NCQA's basic requirements for consumer
protection and quality improvement.
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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.
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Link
to the Michigan HMO Accreditation page on the OFIR website.
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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
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HMOs In Your Area / HMO Enrollment / HMO Complaint Information / HMO Financial Reports / HMO
Accreditation Status /OFIR
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