Which Performance Report on Commercial HMOs & POS Plans

Is Right For You?

The Maryland Health Care Commission (MHCC) is required by state law to develop reports on the performance of commercial (private) HMOs and POS plans that provide health care coverage to consumers in Maryland. The content of each report targets the information needs of different audiences that include consumers, state employees, academics, students, and legislators.

MHCC does not provide performance information for plans that participate in government-sponsored (public) managed health care programs such as Medicare or Medicaid; however, the agencies administering the programs have developed information specific to the performance of the plans under these programs.

The federal agency, The Centers for Medicare and Medicaid Services (CMS), oversees and reports on the quality of Medicare Advantage plans. Performance information about the quality of these plans may be obtained from the CMS website. To view information about Medicare Advantage plans of interest to you, select the following link, Medicare Advantage.

The state agency Maryland Department of Health and Mental Hygiene manages the Medicaid HealthChoice program. The Department’s Consumer Report Card was developed to assist HealthChoice enrollees in comparing and selecting a health plan. Select the following link, HealthChoice to view the MCO Consumer Report Card on the HealthChoice Health Plans.

Easy to Use Reports

· Measuring the Quality of Maryland HMOs and POS Plans: 2007/2008 Performance Report. This report is designed for individuals who are deciding which health plan to join or for employers who are choosing which HMO to offer their employees. HMOs are compared on members’ satisfaction with their plan and the health care that they receive and on the degree to which health care services are provided to members that should receive them.

The 2007/2008 Performance Report is published every fall.

Additionally, legislators and policy-makers, and others who want the "big picture" on the strengths and weaknesses of Maryland's commercial HMO industry can refer to this report to see how Maryland HMOs, collectively, compare to commercial HMos and POS plans in the Mid-Atlantic region and across the United States.

· Measuring the Quality of Maryland HMOs and POS Plans: 2008/2009 State Employee Guide is published for the 80,000 State of Maryland employees who are eligible to receive health benefits. It includes information on the three HMOs and two HMO-linked POS plans offered to state employees.

The State Employee Guide is made available to state employees during the open enrollment period.

Detailed Report

· Comprehensive Performance Report: Commercial HMOs & Their POS Plans in Maryland. Health plan administrators, professional benefit managers, and others who want all the details on how each commercial HMO compares to the others on member ratings (based on results of a member survey) and clinical performance (as defined by HEDIS measures) should refer to this report. The Comprehensive Report is a complete, statistically detailed compendium of the information that forms the basis of the Consumer Guide.In addition to reporting information not found in the Consumer Guide, this report displays plan performance for the most recent three years where data are available for a measure.

The Comprehensive Report is released each fall.

Available Formats: Paper or PDF

PDF, or portable document format, is an electronic method used to create online versions of each report. When visiting the MHCC website, you may choose any of the reports discussed above to view an electronic report that looks the same on your screen as the available paper reports. You may phone 410-764-3460 or to order paper copies of any of these publications.