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Medical Reports

Medical Group Snapshot:

  • Helps patients understand the quality of care they get from their health care providers.
  • Helps providers see where they need to improve.
  • Helps employers become partners in their employees' health.

Medical Group Snapshot tells you how well some Albuquerque medical groups perform in certain areas of medical care. It gives you a "snapshot" of each group's care in these areas.

Medical Group Snapshot shows scores for groups on these treatments and tests:

  • Diabetes care.
  • Heart disease care.
  • Asthma care.
  • Tests to check for breast cancer.
  • Tests to check for cervical cancer.

Medical Group Snapshot also shows scores for:

  • How well patients with diabetes control their blood sugar and cholesterol.
  • How well heart patients control their cholesterol.

Each snapshot shows what percent (%) of patients in the medical group got the prescribed medicines or tests they needed. For a most of the measures, the higher the score, the better. For example, a score of 85% is better than a score of 75%.

For patients with poorly controlled diabetes, a lower number is better.

Medical Group Snapshot also describes:

  • what the scores in the report mean
  • why it's important to test for and treat the problem 

How to Use this Information

Patients want to know where to get good care. Health care providers want to know what they're doing well and where they can improve. Employers want to know if their insurance is paying off in healthier employees.

Scores from the "snapshot" can help patients, providers, and employers talk about quality of care.

But remember, a medical group's quality is more than just the scores on this website:

  • These reports don't cover every health issue the medical groups treat.
  • Health care providers are constantly working to improve all the care they give.

Patients, Families and Caregivers

Here are some things you can do to learn more and make better health care choices:

  • Talk to your provider about what this report means. Discuss how you can partner with your provider for better health.
  • Look at other websites about health care quality.
  • Learn more about your provider's medical group. Visit their website. Talk with friends, family or neighbors who have gone to them.
  • Compare scores from different medical groups.

The scores are not medical advice. These scores are not a substitute for medical evaluation and treatment by a qualified health care professional. Rather, they are here to help you be more informed. They can help you talk with your provider about your care. This is a good step toward being more active in your health care.

For example, if you have diabetes, look at your provider's medical group score for diabetes care. This score shows how the group is doing at giving diabetes patients the blood tests they need. You can talk with your provider about how often you need these tests. This helps make you a better partner with your provider to improve your health.

Health Care Providers

Use this information to:

  • Compare your group to others in these areas of care.
  • Find out what these scores might mean for other areas of care.
  • Find areas where you can improve quality.
  • Answer patients' questions.
  • Teach patients about their health care. Help them become better partners with you.

Employers

Use this information to:

  • Talk to your health insurer about what this information means. Find out how to partner with your insurer to improve the health of your employees overall.
  • Learn about health care quality.
  • Talk to your employees. Remind them how important it is to stay healthy and be good partners with their health care providers.

What are Medical Groups?

A medical group is a group of health care providers with different specialties. Health plans contract with medical groups to offer you health care. Many patients think of their health care provider as "my doctor" or "my nurse." But a provider can be a medical doctor, D.O. (doctor of osteopathy), N.P. (nurse practitioner) or P.A. (physician assistant).

One provider can't take care of every medical need you might have. So a medical group has your main (or primary care) provider and other providers who are specialists. They may all work out of one building. Or they may be spread throughout a region. The health care providers in a medical group work together to make sure you get the care you need.

What's a PCP (Primary Care Provider)?

PCPs (or Primary Care Providers) have special training in one of these areas:

  • Children's medicine (pediatrics).
  • Family medicine.
  • Women's medicine (obstetrics and gynecology).
  • Internal medicine.

You may see your PCP for most of your health care. Here are some examples:

  • Screening tests and other preventive services.
  • Care for short-term (acute) health problems (like the flu or an injury).
  • Care for long-term (chronic) problems (like diabetes).
  • Emotional and mental health issues (like depression or a drug problem).

Your PCP may also coordinate the other health care services you need.

What's a Specialist?

A specialist has in-depth training in a special area of health care. Specialists treat a certain disease or health problem. They may also give ongoing care for a certain health care need. Some examples of specialists are:

  • Surgeons (cut open the body to repair or remove problems).
  • Urologists (treat the urinary tract and male sex organs).
  • Radiologists (use X-rays to test for and treat disease).
  • Cardiologists (treat heart problems).
  • Dermatologists (treat skin problems).

What Medical Group Snapshot Shows

Medical Group Snapshot shows how medical groups are performing in selected measures. To show you how many people got the care they needed, the snapshot shows the percent of patients who got these kinds of care.

For example, the diabetes care scores show the percent of patients with diabetes who got two tests:

  • A1C test—measures a patient's average blood sugar for the past two or three months. 
  • LDL test—measures the level of "bad" cholesterol in the blood.

These tests are recommended for patients with diabetes. We call them "standards of care" for diabetes. Standards of care get the best results for patients with a certain disease or problem. The higher a medical group's score, the better the group did at delivering the standard of care.

The scores are based on a certain period of time, a "snapshot in time." This report currently shows scores based on 12, 24 or 36 months of data ending in December 2011.

Remember that a medical group's quality is more than just the scores in this report. A provider can order a test or prescribe a medicine. But it's up to the patient to have the test done or use the medicine as ordered. Patients need to do their part to get quality care and stay healthy.

Also, each medical group serves a different population, with its own challenges. The report scores don't adjust for these differences.

Studies have shown that language, culture, income and education can all affect health outcomes. To learn more about these studies, please visit one of these sites:

A missing score may appear as "Data Not Available" for two reasons:

  1. There were no numbers for this measure from this medical group. OR
  2. There were not enough patients needing the test or medicine to include in the report.

Where the Data Comes From

Five Albuquerque medical groups take part in Medical Group Snapshot right now. They are:

  • First Choice Community Healthcare
  • First Nations Community HealthSource
  • Indian Health Service - Albuquerque Service Unit
  • Presbyterian Medical Group
  • University of New Mexico Medical Group

The numbers used to figure the scores came from Albuquerque health plans. These health plans are:

  • Blue Cross Blue Shield of New Mexico
  • Lovelace Health Plan
  • Molina Health Care of New Mexico
  • Presbyterian Health Plan

The health plans gave data to  to analyze and report. They did this on behalf of the New Mexico Coalition for Healthcare Quality. (See Technical Appendix for more information.) Health plans did not give names or other data that could identify specific patients. This report currently shows scores based on 12, 24 or 36 months of data ending in December 2011.

A Special Thank You to...

We extend special thanks to the HealthInsight New Mexico and its staff. They gave a great deal of help and support to our efforts in creating this report. We are also grateful to the staff of all the participating health plans and medicals groups for their help and efforts in creating this report.

Sources

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). The HEDIS benchmarks contained herein are owned and copyrighted by NCQA and are included in this publication with the permission of NCQA. The HEDIS benchmarks pertain to performance measured at the health plan level and do not represent any standard of medical care. The benchmarks are provided "AS-IS" without any warranty of any kind including but not limited to any warranty of accuracy or fitness for a particular purpose.

©2010 National Committee for Quality Assurance. All rights reserved.

Note: Please see our disclaimer.

An initiative of the New Mexico Coalition for Healthcare Quality and the Robert Wood Johnson Foundation, with additional funding provided by HealthInsight New Mexico