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Quality Ratings Can Help You Choose Group Health Insurance

Each year, you shop around for the best choice in health care coverage for your employees. Of course, you want to give them a plan with access to the best hospitals and to doctors who can deliver care to meet any need. But along with connecting your employees to great care, the plan also must be affordable — both for them and for your company or organization.

So where should you start? And whom can you trust?

To get a well-rounded picture of how health care providers stack up, it’s best to consult several resources and draw your own conclusions. Following is a general road map of information resources that can help you get started.

Information From Public Sources

Government Agencies

A good place to start is your state’s insurance department, health department or other government agency that regulates health care providers and/or insurers. Such entities require care providers and insurers to regularly report quality and outcomes data — like rates for medical errors, hospital-acquired infections, patient readmissions following inpatient stays for specific conditions, and other key indicators. Check your state’s general website to learn more and connect to the proper regulatory agency.

On the federal level, the Centers for Medicare & Medicaid Services (CMS) regulates health care providers and insurers who treat and administer health benefits for Medicare and Medicaid patients. CMS holds doctors, hospitals and insurers to rigid standards and requires them to report quality data regularly and manage costs.

Accrediting Agencies

Independent, not-for-profit accrediting entities like the National Committee for Quality Assurance (NCQA) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) offer useful insights to health care providers’ and health plans’ capabilities and track records. These entities require care providers and insurers to meet strict quality standards and either complete regular on-site performance surveys or complete clinical practice certification requirements to earn key ratings denoting them as providing high-quality care for specific conditions.

News Media

The annual Best Hospitals list compiled by U.S. News & World Report remains another popular source for hospital quality evaluations. Ranking hospitals in 16 specialties, the magazine uses information from CMS, the American Hospital Association (AHA) and the National Cancer Institute, along with physician input obtained from hospital reputation surveys.

Taking Data a Step Further

Apart from government agencies, accrediting organizations and media outlets, a growing number of health care analytics companies — some nonprofit organizations, others for-profit entities — are emerging. Concerned by health care quality and rising costs, employers and regional consortiums that buy benefit plans for schools and other entities are seeking reliable, third-party information on doctors, hospitals and insurers. And health care analytics companies are answering the call.

Comparion Medical Analytics LLC has emerged as a supplier of objective data on hospital and physician quality, patient safety, care outcomes and cost. The firm obtains much of its data from government sources, including Medicare and the Agency for Healthcare Research and Quality (AHRQ), analyzes it and then uses a proprietary formula to award doctors and hospitals a composite score and rating, Comparion’s website explains.

What makes Comparion’s data valuable, it says, is that the firm compiles quality, outcomes and cost data for all hospitals regardless of their number of licensed or staffed beds. Comparion scores each hospital across several categories, such as patient safety, inpatient care quality, and rates for complications, mortality and readmissions. Scores are then adjusted for case complexity and patient morbidity — factors not considered by some other ratings organizations, Comparion says.

Hospital-Reported Safety Data

With regard to hospital safety, The Leapfrog Group, a national nonprofit organization, releases safety and quality performance information about U.S. hospitals. The organization produces the annual Leapfrog Hospital Survey, a voluntary survey assessing inpatient care safety and quality for high-risk surgeries, maternity care, ICU physician staffing levels and other areas at hospitals that self-report the data. Last year, 1,750 hospitals submitted a Leapfrog Hospital Survey, the organization’s website says, so not all hospitals in your area may have completed the survey.