PacifiCare’s quality index explained

Cypress-based PacifiCare of California has developed an extensive quality index of medical groups.The quality index will be sent to PacifiCare members twice a year. Here is a look at how it works:

• The Quality Index includes only provider groups with more than 1,000 PacifiCare members, and 500 Secure Horizons. Secure Horizons is PacifiCare’s Medicare risk product.

• The report uses the most recently available 12 months of data. For each indicator, the provider group’s performance rate was converted to a percentile ranking relative to all other groups.

• PacifiCare has solicited provider feedback and error correction to help improve the completeness and accuracy of the data submitted by participating providers.

• PacifiCare has developed computer systems to capture information from member surveys, phone calls, and correspondence.

• The company conducted focus groups with brokers, consultants, and providers in developing the Quality Index.

The quality indexes include the following:

— commercial cervical cancer screening;

— commercial mammography;

— Secure Horizons mammography;

— commercial congestive heart failure admissions;

— Secure Horizons congestive heart failure admissions;

— commercial access-related complaints;

— Secure Horizons access-related complaints;

— commercial transfers;

— Secure Horizons voluntary disenrollments;

— benefit appeals;

— member satisfaction with participating medical group;

— member satisfaction with primary care physicians.