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How Is Quality Measured?

More and more public and private groups are developing and using quality measures. Measures are used to check up on and improve the quality of health plans, doctors, hospitals, and other providers of health care. Consumer ratings and performance measures are the two main types of quality measures.

  • Consumer ratings tell you what people like you think about their health care. Consumer ratings of health plans may come from a survey called Consumer Assessment of Health Plans (CAHPS®). The survey was developed by the Agency for Healthcare Research and Quality. The questions in CAHPS® ask people about the quality of care in their own health plans. Their answers can help you decide whether you want to join one of those plans.
  • Clinical performance measures (also sometimes called "technical quality" measures) look at how well a health plan or hospital prevents and treats illnesses. HEDIS—the Health Plan Employer Data and Information Set—is a set of performance measures that rates the quality of HMOs and other managed care plans. One example of a HEDIS measure is whether health care providers in the plan advise smokers to quit.

Both CAHPS® and HEDIS are based on research about the kinds of health care that lead to better results for patients.

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