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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.