Data & Statistical Reports

Managed Care Performance Monitoring

Data for Researchers:  
2006 -- 2005 -- 2004 -- 2003 -- 2002 -- 2001 -- 2000

Guidelines for Researchers
How Scores Were Calculated

About the Consumer's Guides to Managed Care in Missouri

The Missouri Department of Health and Senior Services is pleased to publish on our Website the easy-to-read brochures and the detailed booklets of the 2000 Consumer's Guides to Managed Care in Missouri. The guides provide information on how well managed care plans (HMO and POS) are performing in their responsibility to provide high-quality health care and customer service to their members. They are designed as informational resources to help consumers, employers and other purchasers with their plan selection decisions. These guides may be freely downloaded or printed.

The Consumer's Guides score managed care plans on how well they do in areas that indicate the quality of care provided to their members. For example, the commercial and Medicare guides note whether the plans are above or below the state's managed care average in their rate of providing breast cancer screening, their care of patients with diabetes or depression, rate of members being prescribed beta blocker medications after heart attacks and, for commercial plans only, their rates of prenatal care early in pregnancy and cesarean sections. Indicators specific to MC+ plans are available, also.

Additionally, the publications identify those plans with higher-than-average or lower-than-average member satisfaction scores, based on surveys conducted for the plans by NCQA-certified vendors. A broad range of issues is covered, including question s about getting timely and appropriate care, courtesy of provider staff, doctor communications and the health plan's customer service.

Included in the guides are descriptive profiles of the commercial and Medicare plans. Information can be found on the provision of screening, case management or educational materials for specific medical conditions such as asthma, sickle cell anemia, obesity and women's cancer. The availability of selected prevention services and plan benefits for each plan is also reported.

Guidelines for Researchers
The Missouri Department of Health and Senior Services has attempted to publish accurate information based upon common definitions. Information for the report was gathered from a variety of sources, including data submitted by the managed care plans and audited or collected by independent firms licensed by the National Committee for Quality Assurance. Links to MS Excel spreadsheets that contain the supporting data (frequencies, rates, numerators, and denominators) for the scores and other data found in the Consumer's Guides can be accessed at the Department of Health and Senior Services site.

Investigators are encouraged to access the managed care plan-level data for valid research purposes. Users of this data MUST acknowledge, at a minimum, the Missouri Department of Health and Senior Services, Bureau of Health Informatics (BHI) as the source of the data. Any modifications or manipulations of this data or the published scoring results must be explicitly identified along with the published modifications or manipulations. The Department of Health and Senior Services is not responsible or liable in any way for third party interpretations or misuse of this data.

Managed care plans were given an opportunity to review and correct the data presented. Other corrections or suggestions should be forwarded to the Missouri Department of Health and Senior Services, at the address listed under Contact Us. Additional published copies of the guides can be obtained from the Department of Health and Senior Services at a cost of $1 for the brochure and $3 for the booklet. Volume discounts are available. A companion technical report, containing the data and statistical formulas used, is also obtainable for $10.

The Missouri Department of Health and Senior Services is an equal opportunity/affirmative action employer. Services are provided on a nondiscriminatory basis. This information is available in alternate formats to citizens with disabilities.

How Scores for Performance and Satisfaction Indicators From Missouri Managed Care Plans Were Calculated for the 2000 Consumer's Guides
The Missouri Department of Health and Senior Services (DHSS) requires each calendar year that Missouri managed care health plans submit independently audited, nonbirth-related HEDIS® performance rates as specified by the National Organization for Quality Assurance (NCQA). This submittal must be reported by product line: commercial, Medicare and MC+. Birth-related indicators reported by DHSS are based on the equivalent HEDIS® measures, but are determined by linking Missouri birth record data to enrollment data provided by the commercial plans or the Missouri Department of Social Services.

Commercial plans, and MC+ Medicaid managed care plans upon contract renewal in 2000 or 2001, must conduct CAHPS® adult satisfaction surveys and submit member level results according to NCQA guideline specifications. MC+ member satisfaction data, prior to MC+ plan contract renewal in the 2000-2001 contracting cycle, has been collected by the Division of Medical Services using a modified adult CAHPS® instrument. However, MC+ member satisfaction results were not reportable in the 2000 Consumer's Guide cycle due to low response rates. Medicare CAHPS® results are obtained from the U.S. Center for Medicare and Medicaid Services (CMMS).

Financial and enrollment data are obtained by DHSS from the Managed Care Section in the Missouri Department of Insurance. Information on the benefits and referral/prior authorization policies offered to members from each plan within a product line is collected through an Access to Care questionnaire.

Two of the indicators, Immunizations for Children and Adolescents, were compared to expected performance benchmarks. A managed care plan rate of 70% or higher was scored high; rates less than 50% scored low. Statistical tests were used to assign scores of High, Average and Low for each of the other performance and satisfaction indicators. Birth-related indicators (i.e. Early Prenatal Care, Cesarean Section and Vaginal Birth After C-Section) for the commercial plans were tested against the statewide rates for both managed and non-managed care women. All other indicators were tested against the average of managed care plan rates.

The statistical tests used for the plan scores can determine, within a specified level of confidence, whether the variation seen between a plan's rate and the state average of plan rates for a measure are due simply to chance or represent a meaningful difference. These test scores do not signify a plan's performance against some health care standard. Methods used for statistical testing are described in the Managed Care Technical Report or can be identified by calling the number listed under Contact Us.

Authority to collect these data and publish reports comes from the state statute RSMo 192.068 and Department of Health and Senior Services administrative rule 19 CSR 10-5.010. The information required by managed care plans for submission is specified in the DHSS rule and may change annually.