Which Performance Report on Commercial Managed Care 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 . Preferred provider organizations (PPOs) have voluntarily joined this initiative. 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 Managed Care Plans: Performance Report. This report is designed for individuals who are deciding which health plan to join and for employers who are choosing which HMO or PPO to offer their employees. HMOs and PPOs are compared on members’ satisfaction with their health plan and how often their members receive recommended health care.

The Health Plan 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 managed care industry can refer to this report to see how these Maryland plans, collectively, compare to commercial managed care plans in the Mid-Atlantic region and across the United States.

· Measuring the Quality of Maryland HMOs and POS Plans: 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 HMO, POS, and PPO Plans in Maryland. Health plan administrators, professional benefit managers, and others who want all the details on how each type of commercial plan compares 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-style reports. In addition, 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.