QHP

2019 Utah Health Plan Patient Experiences Report

This report describes how satisfied health plan members are with their experiences obtaining care from their Qualified Health Plan (QHP). These data come from an annual survey entitled the Qualified Health Plan Enrollee Experience Survey. All QHPs are required to conduct the survey through a CMS-approved survey vendor using a standardized survey protocol. The purpose of the report is to give consumers and purchasers information they can use to make an informed decision when selecting a health plan.

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Qualified Health Plan Enrollee Experience Survey

Under the Affordable Care Act (ACA) a Qualified Health Plan (QHP) is an insurance plan that is certified by the Health Insurance Marketplace, and meets ACA requirements such as coverage of essential health benefits. QHPs are insurance plans that: (1) Have been certified by the state Health Insurance Marketplace (“Exchange”); (2) Provide coverage of essential health benefits; and (3) Follow established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts). All QHPs offer the same core set of benefits, including preventive services, mental health and substance abuse services, emergency services, prescription drugs and hospitalization. Some plans include benefits beyond the core set.

There are two different types of measures for the Survey: ratings and composite measures.

For the ratings, four questions assess overall consumer satisfaction with health care, personal doctor, specialist seen most often, and health plan. Response options for overall rating questions range from 0 (worst) to 10 (best). In the results below, ratings of 8, 9, or 10 are considered achievements, and the achievement score is presented as the proportion of members whose response was an achievement.

A composite score is calculated for the two domains of member experience: Getting Needed Care, Getting Care Quickly, How Well Doctors Communicate, and Customer Service. The composite scores provide a summary assessment of how the plan performed across the domain.

Doctor Rating

Plan Measure Rate, Plan Year 2020
SelectHealth Marketplace 86.27
U of U Healthy Premier Individual Marketplace (EPO) 89.36

Health Care Rating

Plan Measure Rate, Plan Year 2020
SelectHealth Marketplace 78.28
U of U Healthy Premier Individual Marketplace (EPO) 83.71

Health Plan Rating

Plan Measure Rate, Plan Year 2020
SelectHealth Marketplace 69.12
U of U Healthy Premier Individual Marketplace (EPO) 72.06

Specialist Rating

Plan Measure Rate, Plan Year 2020
SelectHealth Marketplace 82.95
U of U Healthy Premier Individual Marketplace (EPO) 88.51

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Access to Care Composite

The Access to Care composite is made up of four items. It asks about member experiences with receiving care and getting appointments in a reasonable amount of time (Questions 20 and 21) and member experiences when attempting to get care from doctors and specialists in the last six months (Questions 23 and 39). The Summary Rate represents the percentage of respondents reporting “Always” or “Usually.”

Plan Measure Rate, Plan Year 2020
SelectHealth Marketplace 77.35
U of U Healthy Premier Individual Marketplace (EPO) 74.73

Care Coordination Composite

The Care Coordination composite is made up of six questions and asks members to report whether their doctor had medical records or other information about their care and whether the doctor talked about prescription medicines. This composite also contains questions asking members if they got help managing their care and if the doctor was informed and up-to-date about their care from specialists. Additionally, this composite evaluates whether the member’s personal doctor’s office followed up to give them test results and if they got the test results as soon as they needed (Questions 31, 32, 33, 34, 37 and 41). The Summary Rate represents the percentage of respondents reporting “Always” or “Usually.”

Plan Measure Rate, Plan Year 2020
SelectHealth Marketplace 79.76
U of U Healthy Premier Individual Marketplace (EPO) 83.55

Data Source: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/ACA-MQI/ACA-MQI-Landing-Page.

Data Note: Data represented in these tables represents data collected in 2019, asking respondents about their care in the previous six months.

 

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Content updated January 2020