Systems (CAHPS), which was developed by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ). The questions in the CAHPS survey ask patients to evaluate the quality of care in their own health plans. Their answers can help you decide whether you want to join one of them.
Clinical performance ratings focus on how well a health plan or hospital prevents and treats illnesses. One of the best places to look is HEDIS — the Healthcare Effectiveness Data and Information Set — a set of performance measures that rates the quality of HMOs and other managed-care plans.
For example, HEDIS evaluates the quality of care based on things like whether 2-year-olds are up to date on their recommended shots, and whether health care providers in the plan advise smokers to quit. (Remember that HEDIS only measures a very few items related to health care, and may miss many things that a health plan or health provider does well or poorly.)
States, employers, health plans, and groups like the California-based Pacific Business Group on Health use HEDIS performance measures to prepare reports, often known as “report cards,” for consumers. These also may include HEDIS member satisfaction ratings or other consumer ratings.
To find out if a CAHPS or HEDIS survey report is available for the plans you are considering, contact your employer, the health plan, or a Medicare or Medicaid office. You can also call your state department of health or insurance commissioner’s office. For help in finding your state health insurance contact, visit or call the National Association of Insurance Commissioners.
Where can I find out about health plan accreditation?
An organization called the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) evaluates and accredits all types of healthcare organizations, particularly those most closely related to improving health outcomes. Its standards cover