It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF

More documents

Recommendations

Info

Choose Quality QUALITY COMPOSITE RATING CHARTS The following are descriptions of the rankings displayed in the chart on the next page. Overall Quality Score The overall score is based on a comprehensive set of CAHPS ® and HEDIS ® measures. All the measures that are included in the four areas of focus described below are included in the overall quality score. Wellness and Prevention Score This score includes HEDIS ® measures such as childhood immunizations, well child visits, prenatal and postpartum care, the appropriate use of antibiotics for children and adults, and breast, cervical and colorectal cancer screenings. This composite also includes CAHPS ® questions surveying our members about whether wellness information is provided by their doctor. Behavioral and Mental Health This score includes HEDIS ® measures for the treatment of depression and follow-up after a hospitalization for mental illness. This composite also includes CAHPS ® survey questions on whether members could obtain needed treatment or counseling for a personal or family problem. Disease Management This score includes HEDIS ® measures that address treatment and screenings for members with acute cardiovascular conditions, hypertension, diabetes, chronic obstructive pulmonary disease and asthma. This composite also includes a measure that addresses monitoring members who are on persistent medications of interest. Consumer Satisfaction and Experiences This composite includes CAHPS ® scores that measure member satisfaction with their health plan and the health care they received and whether they believed their health plan improved from the previous year. The composite also includes questions about member experiences such as getting needed care, getting care quickly, health plan customer service, finding and understanding information, ease of paperwork, and how claims were processed. Example of information types gathered: CAHPS ® : How often did you get care as soon as you thought you needed it? HEDIS ® : What percentage of women age 42 to 69 had a mammogram within the last two years? Decision Guide Page 60
Quality Composite Rating Chart Understanding the scores for the health plans: 4 stars: well above the average of all health plans (by more than one standard deviation)* 3 stars: above the average of all health plans (by less than one standard deviation)* 2 stars: below the average of all health plans (by less than one standard deviation)* 1 star: well below the average of all health plans (by more than one standard deviation)* Please see previous page for descriptions of the Quality Composite Ratings. Plan Name Overall Quality Wellness & Prevention Behavioral & Mental Health Disease Management Consumer Satisfaction & Experiences Anthem Blues êê ê êêêê êêê ê Arise Health Plan êêê êêê êêê êêê êêê Dean Health Plan êêê êêê êêê êêê êêê GHC of Eau Claire êêê êêê êêê êêê êêê GHC of SCW êêêê êêêê êêêê êêê êêê Gundersen Lutheran êêê êêê êêê êêê êêê Health Tradition êêê êêê êê êêê êê HealthPartners êêê êêê êêê êêê êê Humana - Eastern ê ê ê ê ê Humana - Western ê ê ê ê ê Medical Associates êêê êê êê êêê êêê MercyCare Health Plans êêê êêê êêêê êêê êê Network Health Plan êêê êêê êê êêê êêê Physicians Plus êêê êêê êêêê êêê êêê Security Health Plan êêê êêê êê êêê êêêê UnitedHealthcare NE ê **NR êêê **NR êê UnitedHealthcare SE êê **NR êêê **NR êêê Unity - Community êêê êêê êêê êêê êêê Unity - UW Health êêê êêê êêê êêê êê WEA Trust PPO - East ê **NR êêê **NR êêêê *The standard deviation measures the difference between an individual health plan’s score and the average score of all health plans. We are more certain that health plans with four stars have performed better than average and health plans with one star have performed worse than average. We cannot conclude that health plans with three stars or two stars have performed differently from the average. **NR signifies that not all necessary data was reported. Decision Guide Page 61
Page 1 and 2:
It’s Your Choice: 2013 Decision G
Page 3 and 4:
Table of Contents Choose Wisely....
Page 5 and 6:
Choose Wisely Sheboygan Fiesta Hisp
Page 7 and 8:
Choose Wisely Standard Plan Benefit
Page 9 and 10:
FREQUENTLY ASKED QUESTIONS IT’S Y
Page 11 and 12: Choose Wisely dependents through th
Page 13 and 14: Choose Wisely back of this Guide or
Page 15 and 16: Choose Wisely When you use in-netwo
Page 17 and 18: Choose Your Health Plan radiology (
Page 19 and 20: Local Government Employees and Annu
Page 21 and 22: LOCAL HEALTH PLAN TIERS Choose Your
Page 23 and 24: Choose Your Health Plan HEALTH PLAN
Page 25 and 26: Comparison of Benefit Options BENEF
Page 27 and 28: Comparison of Benefit Options BENEF
Page 29 and 30: Choose Your Health Plan coordinated
Page 31 and 32: Health Plan Features - At a Glance
Page 33 and 34: Anthem Blue Preferred - Northeast N
Page 35 and 36: Anthem Blue Preferred - Southeast N
Page 37 and 38: Dean Health Plan Inc. (800) 279-130
Page 39 and 40: Group Health Cooperative of South C
Page 41 and 42: Health Tradition Health Plan (877)
Page 43 and 44: Humana - Eastern (800) 4humana [(80
Page 45 and 46: Medical Associates Health Plans (80
Page 47 and 48: MercyCare Health Plans (800) 895-24
Page 49 and 50: Physicians Plus (608) 282-8900 or (
Page 51 and 52: Standard Plan Administered by WPS H
Page 53 and 54: UnitedHealthcare of Wisconsin North
Page 55 and 56: Unity Health Insurance - Community
Page 57 and 58: WEA Trust PPO - East (800) 279-4000
Page 59 and 60: WPS Metro Choice Northwest (800) 63
Page 61: Choose Quality HEALTH PLAN REPORT C
Page 65 and 66: CAHPS ® Composite Rating Chart Und
Page 67 and 68: Choose Quality GRIEVANCE AND COMPLA
Page 69 and 70: Choose Quality OTHER QUALITY INFORM
Page 71 and 72: NAVITUS HEALTH SOLUTIONS — Pharm
Page 73 and 74: NAVITUS MedicareRX (PDP)— Pharmac
Page 75 and 76: For Medicare eligible, retired, dis
Page 77 and 78: This page intentionally left blank.
Page 79 and 80: myETF Benefits System Instructions
Page 81 and 82: Department of Employee Trust Funds
Page 83 and 84: ETF Use Only State of Wisconsin Dep
Page 85 and 86: Applicant Name Social Security Numb
Page 87 and 88: DUPLICATE APPLICATION FOR YOUR RECO
Page 89 and 90: DUPLICATE APPLICATION FOR YOUR RECO
Page 91 and 92: Glossary Coinsurance: Your share of
Page 93 and 94: Glossary In-network Copayment: A fi
Page 95 and 96: Glossary Preventive Services: Routi
Page 97 and 98: This page intentionally left blank.
Page 99 and 100: Health Plan Contact Information Ant
show all

It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?