Part of the mission of the Office of Health Care Statistics is to report information about the quality of services provided by Medicaid Managed Care contractors, Children’s Health Insurance Program (CHIP) health plans, commercial insurance companies, and third party administrators. We collect and publish information using national standard measures for quality of services and customer satisfaction.
Utah Health Plan Quality of Care Report (HEDIS)
The goal of Utah’s Healthcare Effectiveness Data and Information Set (HEDIS) report is to provide information for consumers, purchasers, and health plans about the performance of these entities. Most Utahns are covered by a plan in this report and consumers of health care can use this information to help make informed decisions about plan selection. Health plans can also use this information to improve care and services provided to enrollees.
Data collection, analysis, and writing of this report is a collaborative effort led by the Office of Health Care Statistics. The Division of Medicaid and Health Financing, the Utah Health Data Committee, and representatives of the participating health plans contribute to this report.
Utah Health Plan Patient Experiences Data (CAHPS)
The annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey asks health plan enrollees about their recent experiences with health plans and their services. This standardized survey was designed to support consumers in assessing the performance of health plans and choosing the plans that best meet their needs. Health plans can also use the survey results to identify their strengths and weaknesses and target areas for improvement.
The questions for adults and children are slightly different. Based on these differences, the CAHPS survey is on a rotating schedule between adults and children. In odd-years, adult enrollees 18 and over complete the adult questionnaire, and in even-years a parent or guardian completes the questionnaire for those 17 and younger.
Utah Qualified Health Plan Enrollee Report (QHP)
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.
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.