Instructions
OBJECTIVES
• Part 1: To familiarize yourself with different health plan quality measures and ratings done by the National Committee for Quality Assurance (NCQA).
• Part 2: To distinguish between process and outcome measures.
INSTRUCTIONS (There are 5 questions in total, each worth 2 points.)
Note: You may switch between screens to complete this assignment. There is no time limit on this assignment.
PART 1: National Committee for Quality Assurance (NCQA) Plan Rankings
Visit NCQA Website Links to an external site. for the most recent health plan ratings (the last update was 9/15/2024.
This website is hosted by an external party. In the event that the link should stop working, the Professor will provide students with an updated link (likely through a course Announcement).
Answer Assignment Questions in Submission Quiz
Use the filters on the left side of the NCQA rankings page to get the data you need to answer each question. For example, you may need to filter by “Plan Type” (Medicare, Commercial (Private), Exchange, or Medicaid] and/or by “States Served.”
Questions: Here are some examples of the questions you may see in the submission quiz:
Of private (commercial) plans in the State, how many plans received an overall score of 5.0?
Of Medicare plans in the State, how many plans received an overall score of 5.0?
Of Medicaid plans in the State, how many plans received an overall score of 5.0?
(After responding to quiz questions for Part 1, you will see quiz questions for Part 2.)
PART 2: Identifying Process and Outcome Measures
Remember:
Process measures indicate what administrative or procedural “actions” a provider or health plan does to maintain or improve patient health.
Outcome measures reflect the impact of the healthcare service or intervention on the health status of patients. So, outcome measures evaluate the effectiveness or “outcomes” of a patient following the receipt of services, treatment, or procedures.
Examples of both process and outcome measures are included in this chapter’s lecture.
1. Of private (commercial) plans in the State of Arizona, which of the following plans received an overall score of 3.0? (There may be more than one answer.)
Group of answer choices
A.UnitedHealthcare of Arizona
B. Banner Health and Aetna Insurance Company
C. Aetna Life Insurance Company
D. Cigna Health and Life Insurance Comp
2. Of Medicare plans in the State of Kansas, which of the following plans received an overall score of 4.0? (There may be more than one answer.)
A. Group of answer choices
B. Coventry Health Care of Missouri, Inc.
C. Blue Cross Blue Shield of Kansas, Inc.
D. CHA HMO, Inc.
3. Of Medicaid plans in the State of Nebraska, which of the following plans received an overall score of 4.0? (There may be more than one answer.)
A. Community Care Health Plan of Nebraska,Inc. dba Healthy Blue
B. UnitedHealthcare of Midlands, Inc.
C. Molina Healthcare of Nebraska
D. Nebraska Total Care
4. Is the following quality measure a “process measure” or an “outcome measure?”
Patient satisfaction with doctor and office staff interactions.
A. Process
B. Outcome
5. Is the following quality measure a “process measure” or an “outcome measure?”
Number of hospital-acquired infections in a given month at St. Vincent’s Hospital.
A. Process
B. Outcome