A Consumer�s Guide to the HealthChoices Southeast Health Plans by guy21

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									A Consumer’s Guide to the
HealthChoices Southeast
Health Plans
Office of Medical Assistance Programs
Commonwealth of Pennsylvania
Department of Public Welfare




                    C O M P A R E       Y O U R   C H O I C E S




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HealthChoices is all about choice.

          This guide will help you choose the best health plan for you
          and your family.1 If you are already in a health plan, this guide
          will show how your plan compares to other health plans.2

          It is very easy to find out how each plan is doing using this guide.

               Quality of Care-How the plans help you stay healthy.
               Access to Care and Services-How much and how often
               you are able to get care and services from the plans.
               Care for Those with Special Needs-How the plans help you
               get better and live with an illness if you have special needs.
          A number of different measures show how the plans are doing.
          Each measure is described and includes a reason why the measure is important.
          There are symbols next to each measure, one for each plan in HealthChoices Southeast.
                    This symbol means that the plan did the same as, or better than, 75 percent of Medicaid
                    plans in other states.3
                    This symbol means that the plan did better than average.
                    This symbol means that the plan did no better or worse than average.
                    This symbol means that the plan did worse than average.
                    This symbol means that there was not enough good data or too few members.


                                               HealthChoices Southeast Plans
                       AmeriChoice                  Health Partners                   Keystone Mercy                    OakTree

          If you are already a HealthChoices Southeast member, you do not have to
          change your plan or doctor. This guide is for your information only.
          1
              Under the HealthChoices Southeast program, Medical Assistance recipients may choose
              from one of four managed care plans.
          2
              The information for this guide is from 1999 and comes from HealthChoices Southeast consumers and plans.
              Both the plans and the Pennsylvania Department of Public Welfare collected the guide’s information. The
              information came from the Consumer’s Assessment of Health Plans Study (CAHPS), the Medicaid Health
              Plan Employer Data and Information Set (HEDIS), and External Quality Review (EQR).
          3
              The American Public Human Services Association (APHSA) has released a draft set of Medicaid HEDIS
              benchmarks using 1998 data in the 1999 reporting year. The National CAHPS Benchmarking Database
              (NCBD) has released a set of Medicaid CAHPS benchmarks using results from the 1999 CAHPS survey.



 Pennsylvania HealthChoices
Pennsylvania HealthChoices


The Quality of Care provided by health plans is measured by:
Measure                                                                                             AmeriChoice Health Partners   Keystone Mercy   OakTree
Satisfaction with Plan
A good way to tell how well a plan is doing is to ask its members.
You should be happy with your plan and the care you get.
Members gave their plan a " 7" or above on a scale of 0 to 10.


Satisfaction with Child’s Plan
You should be happy with your child’s plan and the care they get.
Members gave their child’s plan a " 7" or above on a scale of 0 to 10.



Getting Care You Need
You should not have a problem getting care you or your doctor
think you need.
Members said it was "No Problem" getting care they or their doctor thought necessary.


Seeing a Specialist
It is important to see a specialist when your regular doctor needs help.
Getting your doctor to refer you to a specialist should not be a problem.
Members said it was "Not a Problem" getting a referral to a specialist.


Vaccines for Children
Vaccines help keep children from getting sick.
Children should get all their vaccines before they turn two.
Children who got their vaccines before turning two.


Early Prenatal Care
You should get care as soon as you think you might be pregnant.
Early care helps you to have a healthy baby at the right time.
Pregnant women who got care in the first three months they were pregnant.


Regular Prenatal Care
If you are pregnant, you should get regular care for you and your baby.
Regular care helps you to have a healthy baby at the right time.
Pregnant women who got over 60 percent of the recommended prenatal care visits.


Finding Cervical Cancer
A Pap test can find cancer early. Finding cancer early and treating it
helps women live longer.
Women between 21 and 64 who had a Pap test sometime in the last three years.


Approved Ear Ache Treatment
Your doctor can let an ear ache get better by itself or use medicine.
The medicine should be the right kind.
Members who got approved medicine to treat ear aches, or no medicine at all.


Watching Your Cholesterol
High cholesterol can cause heart attacks and other health problems.
People who have had a heart attack or other health problem related
to high cholesterol should have their cholesterol checked.
Members who had their cholesterol checked after having a heart attack, bypass surgery, or an angioplasty.



       The plan did the same as, or better than,                               Above Average                Average      Below Average        Incomplete/Missing
       75 percent of Medicaid plans in other states
Pennsylvania HealthChoices


Access to Care provided by health plans is measured by:
Measure                                                                                         AmeriChoice Health Partners   Keystone Mercy   OakTree
Choosing a Doctor or Nurse You Are Happy With
You should be happy with your regular doctor or nurse.
It should be easy to get a new doctor or nurse if you want to change.
Members said it was "Not a Problem" to get a doctor or nurse they are happy with.


Getting an Appointment with Your Doctor or Nurse
You should always be able to see your doctor or nurse as soon as you want.
Members said they "Always" got an appointment with their doctor or nurse for regular or
routine care as soon as they wanted.


Waiting for Plan Approval
Sometimes your plan needs to approve certain kinds of care before you
get the care. You should not have a problem getting approval for care
you need.
Members said delays in care were "Not a Problem" because they were waiting for plan approval.

Starting Prenatal Care in a New Plan
When pregnant women join new plans, they should start prenatal care as
soon as possible. Prenatal care helps you to have a healthy baby on time.
Pregnant women who had a prenatal check-up within six weeks of enrollment in a new plan.


Doctor Visits for Children 12 to 24 Months Old
Even children who aren’t sick need to see their doctors. You should make
sure your child sees a doctor at least once a year. Regular doctor visits
help find any health problems early.
Children 12 to 24 months old who saw a doctor or nurse in the past year.

Doctor Visits for Children 7 to 11 Years Old
Even children who aren’t sick need to see their doctors. You should make
sure your child sees a doctor at least once a year. Regular doctor visits
help find any health problems early.
Children 7 to 11 years old who saw a doctor or nurse in the past year.

Regular Check-ups for Children in the First 15 Months
Children need to see their doctors often before they turn 15 months old.
These check-ups can help make sure that your child is healthy.
Children who saw their doctors three or more times before turning 15 months old.


Having a Regular Doctor or Nurse
A regular doctor makes it easy to get care when you’re sick. It can also
keep you from having to go to the emergency room when you’re sick.
Members who had a visit with their doctor or nurse within the past year.




 C O M P A R E                                                                     Y O U R                        C H O I C E S

       The plan did the same as, or better than,                               Above Average          Average        Below Average        Incomplete/Missing
       75 percent of Medicaid plans in other states
Pennsylvania HealthChoices


Care for Those with Special Needs is measured by:
Measure                                                                                       AmeriChoice Health Partners   Keystone Mercy   OakTree
Language Problems
Not all plan members speak English as their first language.
Members who don’t speak English should still be able to get care.
Members said they "Never" had a problem speaking with or understanding a doctor or
nurse because of language problems.

Satisfaction with Dental Care
You should be happy with the dental care you get.
Members gave their dental plan a " 7" or above on a scale of 0 to 10.



Satisfaction with Your Specialist
A specialist is a doctor who you see when your regular doctor needs help
taking care of you. You should be happy with the care that you get from
your specialist.
Members gave their specialists a "7" or above on a scale of 0 to 10.

Doctor Visits for People 45 to 64 Years Old
Even people who aren’t sick need to see their doctors. You should make
sure you see a doctor at least once a year. Regular doctor visits help find
any health problems early.
Members 45 to 64 years old who saw a doctor or nurse in the past year.

Hepatitis B Testing for Pregnant Women
Hepatitis B is a harmful illness that pregnant women can give their babies.
Pregnant women should be tested for Hepatitis B to help keep their
babies from getting it.
Pregnant women who got a Hepatitis B test.

Eye Check-ups for People with Diabetes
Diabetes is an illness that can make you lose your sight.
Some people with diabetes need to have their eyes checked every year.
Members with diabetes who had their eyes checked either one or two years ago, depending
on how serious their diabetes is.




AZT Use by Pregnant Women
in the Four Plans
                                                                       1999




AZT is a drug that is used to fight HIV and AIDS.                                                                              64%
Pregnant women with HIV or AIDS should take
AZT to help keep them from passing on HIV and
AIDS to their babies.
Pregnant women with HIV or AIDS in the HealthChoices
Southeast program who received, or who were recommended
to receive, AZT.




       The plan did the same as, or better than,                              Above Average         Average        Below Average        Incomplete/Missing
       75 percent of Medicaid plans in other states
Important Numbers

 To learn how to enroll in a health plan or change your health plan, call:
 HealthChoices Hotline         1-800-440-3989        TTY 1-800-618-4225
 If you have a question about your health plan, you can call them at these numbers:
 AmeriChoice                  1-800-321-4462         TTY 1-800-654-5984 (PA Relay)
 Health Partners              1-800-553-0784         TTY 1-215-849-1579
 Keystone Mercy               1-800-521-6860         TTY 1-800-684-5505
 OakTree                      1-800-959-6258         TTY 1-800-654-5984 (PA Relay)
                                    For copies of this guide, or to request this information in another
                                 form, such as Braille, large print, or audio tape, call: 1-800-440-3989.
                                     This guide is also available on the web: www.dpw.state.pa.us



 Commonwealth of Pennsylvania                                                                                          Tom Ridge
 Department of Public Welfare                                                                                            Governor
 Office of Medical Assistance Programs                                                                      Feather O. Houstoun
 Post Office Box 2675                                                                                                   Secretary
 Harrisburg, Pennsylvania 17105
                                                                                                            Peg J. Dierkers, Ph.D.
                                                                                                                  Deputy Secretary,
 Prepared by the Office of the Medical Director                                                                   Office of Medical
                                                                                                               Assistance Programs




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