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Quality Insights:
Clinical Quality in Primary Care
Questions & Answers
What is MHQP's Quality Insights: Clinical Quality in Primary Care report?
This report has information about the quality of healthcare given to patients in Massachusetts. Using data from 2007, this report looks at information from five employer-based health insurance plans: Blue Cross Blue Shield of Massachusetts, Fallon Community Health Plan, Harvard Pilgrim Health Care, Health New England, and Tufts Health Plan. In all, these health plans provide care in 150 medical groups across the state.
Massachusetts Health Quality Partners (MHQP) prepared this report. MHQP is an independent organization that looks at quality healthcare in Massachusetts. It is made up of doctors, hospitals, health plans, consumers, employers, and government agencies across the state. MHQP's goal is to improve the quality of healthcare by making reliable comparative data available to doctors, medical groups, health plans, and residents of Massachusetts.
MHQP released its first statewide quality report in 2005. That report compared the performance of nine large doctor networks, which totaled more than 3,000 doctors. Since 2006, this report continues to compare the performance of 150 medical groups, with about 4,500 primary care doctors. MHQP plans to issue more reports in the next few years. Future reports will look at the quality of care given by specialists and primary care doctors.
How can this report help patients and their family members?
MHQP is pleased to share this report on quality data with patients, their family members, and the general public. Data in this report can be used to compare the quality of primary care given by medical groups across Massachusetts. Using this data, patients and their family members can be better informed when choosing a medical group or learning about its quality of care.
While this report includes quality data, it tells just part of the healthcare "story." It looks only at medical groups, not individual doctors or health plans. This MHQP report is a good place to start learning about the quality of healthcare in Massachusetts.
What types of healthcare are measured in this report?
This report measures how often primary care doctors provide their patients preventive care services such as breast cancer screening, chronic disease care, and diabetes control. These measures are evidence-based (researched) and recognized nationwide. Data is from the HEDIS® measure set developed by the National Committee for Quality Assurance (NCQA) and used with its permission.
Specific measures in this report are:
- Adult Diagnostic and Preventive Care:
- Colorectal Cancer Screening Tests (Ages 50 to 80)
- Correct Imaging Test Use for Lower Back Pain
- Spirometry Test for COPD (Chronic Obstructive Pulmonary Disease)
- Depression:
- Short-term Medication
- Long-term Medication
- Medication Management:
- Correct Use of Antibiotics for Acute Bronchitis **
- Yearly Follow-Up for Patients on Long-Term ACE Inhibitors or ARBs
- Yearly Follow-Up for Patients on Long-Term Anticonvulsant Medication
- Yearly Follow-Up for Patients on Long-Term Diuretics
- Asthma Care:
- Medications for Children (Ages 5 to 17)
- Medications for Adults (Ages 18 to 56)
- Heart Disease and Cholesterol Management:
- Cholesterol Screening Test for Cardiovascular Disease
- Diabetes Care for Adults:
- HbA1c Test
- Cholesterol (LDL-C) Screening Test
- Tests to Monitor Kidney Disease
- Pediatric Care:
- Well-Visits for Children 0 to 15 Months of Age
- Well-Visits for Children Ages 3 to 6
- Well-Visits for Adolescents Ages 12 to 21
- Correct Antibiotic Use for Upper Respiratory Infections
- Follow-Up with Children Starting Medication for ADHD
- Women's Health:
- Breast Cancer Screening (Ages 40 to 69)
- Cervical Cancer Screening (Ages 21 to 64)
- Chlamydia Screening (Ages 16 to 20)
- Chlamydia Screening (Ages 21 to 25)
** This measure is reported at the state level only. Difference in results among medical groups could be due to different ways the groups bill health plans for this service. While the performance score for any one group may not be accurate, across the state there is significant room for improvement in the correct use of antibiotics for adults with acute bronchitis.
The following measures are reported only at the state level as they are based on sample chart reviews performed by the health plans, and there are not enough cases at the medical group level to validly report these measures at that level.
- Adult Diagnostic and Preventive Care:
- High Blood Pressure Control
- Heart Disease and Cholesterol Management:
- Cholesterol (LDL-C) Good Control
- Diabetes Care for Adults:
- HbA1c-Poor Blood Sugar Control (Lower score is better)
- HbA1c-Good Blood Sugar Control
- Blood Pressure Control
- Cholesterol (LDL-C) Good Control
Who is included in this report?
This report includes information on healthcare services received by members (patients) of five Massachusetts health plans: Blue Cross Blue Shield of Massachusetts, Fallon Community Health Plan, Harvard Pilgrim Health Care, Health New England, and Tufts Health Plan.
These members represent more than half of all Massachusetts residents who have commercial health insurance. This report does not include information on services received by patients without health insurance, or those with Medicaid, Medicare, or insurance companies not listed above.
This report has data for medical groups, not doctors. Are these scores the same?
Not always. Scores are for tests and services given to eligible patients of all primary care doctors in a medical group. A doctor's score is not always the same as his or her medical group.
There are many scores for each medical group. Why isn't there just one overall score?
Each quality measure looks at just one aspect of care. MHQP does not put these measures into an overall score because each score tells only part of the "story" about the quality of care.
Does a low score mean that a medical group gives poor care?
Not necessarily. A low score can simply mean that the medical group needs to improve in that one aspect of care. Medical groups are working hard to improve healthcare. MHQP expects these improvements to show up in future quality reports.
Also, the results of these measures can be affected by many things including the types of systems the medical group has to support high quality care (such as electronic medical records or systems for following up with a patient), as well as how often patients see their physicians and follow recommendations.
In addition, each quality measure looks at just one aspect of the care. A medical group with one low score can still give good care in other areas. Compared to other parts of this country, Massachusetts doctors do very well on these quality measures.
How can I find my doctor's score?
MHQP does not report on individual doctors. This is because data is sometimes so small that it can be misleading or change from year to year.
But you can find data on a doctor's medical group. To do so, go to the Clinical Quality Report page and type your doctor's name where it says, "enter your doctor's last name". If in 2007 the doctor was in a medical group that is included in this report, that group's name will be displayed. If a doctor practices with more than one medical group, his or her name may appear more than once.
To be in this report, medical groups must have at least 3 doctors and 2 measures with enough patients to report on. Doctors who practice alone or with just 1 other doctor are not included in medical groups but are part of statewide scores.
Doctors were assigned to medical groups using information from medical groups and health plans. You can learn more by going to the Technical Appendix.
How can I find my health plan's score?
MHQP's report looks only at medical groups, not health plans. To learn more about the performance of health plans in Massachusetts, go to the National Committee for Quality Assurance website at www.ncqa.org.
How was data collected for this report?
The data in this report was given to MHQP by health plans. It is based on doctors' and pharmacies' claims for services given to the plan's members in 2007. These data were chosen because research shows that these claims are valid and good measures of service.
To learn more, go to the Technical Appendix.
How does MHQP know its data is correct?
MHQP confirms that its data is correct in these ways:
- Health plans validate (confirm that it is correct) data sent to MHQP. This is done by independent auditors (companies not part of health plans)
- An independent consultant does an audit (review) of the methods MHQP uses to combine information and calculate performance scores. This is done to confirm that MHQP accurately calculates HEDIS results at the medical group level for each service that is measured.
What is a medical group’s Performance Rate?
A medical group’s performance rate is the percent of the group’s patients who received the recommended service among all the group’s patients who should have received it.
What are benchmarks?
Benchmarks are standard performance rates used to judge how well a group is performing. For example a group may look like it is not doing well if it gets a rate of 70% but if most other groups are getting rates of 40%, the group with 70% is doing much better.
What benchmarks are used in this report?
In this report, we have used the MA Statewide Rate and two National Performance Rates as benchmarks. This year we have added a new benchmark, the Performance Goal, for some of our measures.
How does MHQP determine the MA Statewide Rate?
Among all the five health plans’ members who should have received a recommended service, the percent who actually did receive it is the MA Statewide Rate.
How does MHQP determine national scores to compare each measure?
The State of Health Care Quality 2008 is the source for national scores. It includes results of the same HEDIS® measures from health plans across the country. Each year, NCQA analyzes and publishes these scores in the State of Health Care Quality.
NCQA determines the average scores and the 90th percentile scores of all the health plans, and uses these scores as national benchmarks. MHQP uses these rates because they are the only nationwide data on clinical HEDIS rates. To learn more about rate development, go to the Technical Appendix.
What does the NCQA national average score measure?
The national average score is the average Performance Rate for each measure for all health plans that gave clinical quality performance data to NCQA.
What does the NCQA national 90th percentile measure?
The national 90th percentile is the Performance Rate that only 10% of all health plans giving clinical quality performance data to NCQA reached or exceeded.
What is the Performance Goal benchmark?
The Performance Goal is the score reached or exceeded by the top 25 percent of all Massachusetts medical groups in the previous year for specific measures. As an additional recognition of performance, a group can earn a maximum of 5 stars on those measures with a performance goal. Measures that are too new or have recent changes in the way they are calculated do not have a Performance Goal. A maximum of 4 stars is possible for these measures.What do the star ratings mean?
If a medical group had 30 or more patients eligible for the service being measured, the group received 1 gold star. An additional gold star was awarded for each benchmark where the medical group's performance was better than the benchmark.
What are the green bars that are shown where different groups are compared on the same measure?
The green bar (
) shows a 95% confidence band around the performance rate.
This means that if a medical group’s whole green bar is to the right
of another group’s green bar, it is likely that a greater percent of
patients in that group received needed service than did patients in
the other medical group.
If a medical group’s whole green bar is to the right of the State Rate, it is likely that a greater percent of patients in that group received needed service than did patients being served by many other medical groups in the state.
If a medical group’s whole green bar is to the right of the national average, it suggests that group is doing better at getting the needed service to its patients than are groups in the nation on average.
If a medical group’s whole green bar is to the right of the national 90th percentile rate, it suggests the group is doing extremely well at getting the needed service to its patients when compared to most physicians in the rest of the country.
About Massachusetts Health Quality Partners (MHQP)
MHQP is a broad-based coalition of doctors, hospitals, health plans, purchasers, consumers, academics, and government agencies that work together to promote the improvement of quality healthcare in Massachusetts. MHQP was started in 1995 by healthcare leaders in Massachusetts who recognized that valid, comparable measures help drive quality improvement. MHQP now provides reliable data to help doctors improve the quality of patient care and also to help consumers make informed choices about their healthcare.
MHQP member organizations include Blue Cross Blue Shield of Massachusetts, Fallon Community Health Plan, Harvard Pilgrim Health Care, Health New England, Neighborhood Health Plan, Tufts Health Plan, Massachusetts Hospital Association, Massachusetts Medical Society, Massachusetts Executive Office of Health and Human Services, MHQP Physician Council, two consumer representatives, one employer representative, two academics, and two independent health industry representatives.
The MHQP Physician Council includes medical directors from 14 large doctor organizations, including Baycare Health Partners; Beth Israel Deaconess Physician Organization; Caritas Christi Health Care System; Boston Medical Center; Fallon Clinic; Lahey Clinic; Harvard Vanguard Medical Associates/Atrius Health; Mt. Auburn Cambridge IPA; New England Quality Care Alliance; Partners Community Healthcare, Inc.; Pediatric Physicians Organization of Children's Hospital Medical Center; Riverbend Medical Group; South Shore PHO; and UMass Memorial Health Care.
About data in this report:
Quality Compass® 2008 is the source for the national benchmark and quality measure definitions in this report. These benchmarks and definitions are used with the permission of the National Committee for Quality Assurance (NCQA). Any analysis, interpretation, or conclusion based on these data is solely that of MHQP, and NCQA specifically disclaims responsibility for any such analysis, interpretation, or conclusion.
Quality Compass® and HEDIS® are registered trademarks of NCQA. NCQA is a private, non-profit organization dedicated to improving healthcare quality.
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