Project Overview

  • What is HealthQuality CT?

    HealthQuality CT is a free resource to learn more about the quality of healthcare delivery in CT.

    • Healthcare consumers and their caregivers can learn more about how the place where they receive care compares to state averages and to other organizations.
    • Healthcare providers can see how their own and other organizations rate. This information can be used to improve healthcare quality.
    • Healthcare policy makers and advocates can check quality care ratings for specific measures and for healthcare organizations overall to inform statewide healthcare quality improvement initiatives and policies.
    • Healthcare payers can check quality ratings for specific healthcare organizations to see how the care delivered compares to state averages. This information can be used to inform value-based payment initiatives.

    The HealthQuality CT website allows anyone to view and compare healthcare quality ratings of some of the largest healthcare organizations in Connecticut. You can use the Scorecard reports to explore results for approximately 30 healthcare quality measures topics such as patient satisfaction, child well care visits, hospital readmission rates, and many more. The Scorecard allows you to search, sort, and filter results by healthcare organization, health topic, and rating. You can view all rated healthcare organizations and all of their healthcare quality scores at once. Or, you can select any combination.

    The quality ratings compare a healthcare organization’s performance score for each measure to a statewide average. Every score is rated as being above the state average, average, or below average. You can choose to view the results in a table or on a graph. For many measures, you can also view the “top performer” score and national scores for comparison.

    Definitions and explanations are available throughout the website if you hold you mouse over the , or over the results displays and if you click on phrases such as Learn More, Show More or Show Example. Additional text will then appear to provide more information on many features of the Scorecard. For each healthcare quality measure, visit the Quality Measure Report for links to external websites with information on that particular medical condition or treatment.

    You can also go to any rated healthcare organization’s website from its Healthcare Organization Report. A link is provided under the title “Read more.”

  • Who created and maintains HealthQuality CT?

    The HealthQuality CT Scorecard is a project of the Connecticut Office of Health Strategy’s State Innovation Model (SIM) Program Management Office, in partnership with its Quality Council workgroup and the SIM Evaluation Team at the UConn Health’s Center for Population Health. The SIM program, a Center for Medicare & Medicaid Innovation (CMMI) initiative, supports the development of payment and service delivery model reform to promote healthier people, better care and smarter spending. Connecticut SIM, which includes the Scorecard, is funded in part by a grant from CMMI.*

    The SIM Evaluation Team at UConn Health created and maintains the HealthQuality CT website and conducts the performance measure score and rating calculations that appear in the Scorecard. Connecticut’s Quality Council provided oversight, reviewed and approved the overall design, and made key decisions about the Scorecard’s development, including attribution, benchmarks, and ratings, among other things. Members of the Quality Council include healthcare providers, health insurance experts, patient advocates and other experts from across the healthcare and related sectors in Connecticut.

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    • * Disclaimer: The project described was supported by Grant Number 1G1CMS331630-01-05 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services, or any of its agencies. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the findings of the independent federal evaluation contractor.
  • What are the healthcare quality measures?

    What are quality measures? Healthcare quality measure are tools that help us measure aspects of healthcare delivery that are associated with high-quality patient care. Healthcare quality measures are commonly designed to identify if providers deliver patient care in an effective manner; that is, do providers deliver services to all who would benefit and not to those patients who are unlikely to benefit. Quality measures can address many aspects of patient care such as clinical processes, care coordination, efficient use of resources, health outcomes and patient safety. For example, quality measures related to a chronic condition may look at how often members with a certain condition get the recommended test or treatment to help manage their condition.

    What are the healthcare quality measures for the Scorecard? In 2016, Connecticut’s SIM Quality Council issued a report containing recommendations for a “Multi-Payer Quality Measure Set for Improving Connecticut’s Healthcare Quality.” Approved by Connecticut’s Healthcare Innovation Steering Committee, the Multi-Payer Measure Set includes 31 core measures, 16 development measures and 11 reporting measures. Most of the measures are used nationally and endorsed by medical quality experts such as the National Committee for Quality Assurance (NCQA) and National Quality Forum (NQF). A few were created or adapted specifically for Connecticut’s healthcare context.

    The Quality Council reviewed the Multi-Payer Quality Measure Set’s core measures and reporting measures to create the list of measures for the first Scorecard report with plans to review the list annually. The first Scorecard features 16 core measures, 7 reporting measures and 2 replacement measures from the Multi-Payer Quality Measure Set. This other measures required electronic health record data, rather than the available claims data; therefore, those measures were not selected for the Scorecard. The selected measures cover a wide range of healthcare quality areas, such as prevention, chronic disease, and behavioral health.

    Show list of the 33 healthcare quality measures used for the 2018 Scorecard.

  • What healthcare organizations are rated?

    Connecticut’s State Innovation Model Program Management Office determines which healthcare organizations are rated on the Scorecard. Each organization provides comprehensive primary care and has the ability to implement large-scale payment and health quality improvement programs.

    The Scorecard rates some of the largest healthcare organizations in Connecticut. The rated healthcare organizations belong to one of two major types: Advanced Networks and Community Health Centers.

    • Advanced Networks include independent practice associations, large medical groups, clinically integrated networks, and integrated delivery system organizations that have entered into shared savings plan arrangements with at least one payer.
    • Show list of the 18 Advanced Networks rated for the 2018 Scorecard.

    • Community Health Centers are nonprofit healthcare practices that provide affordable, comprehensive primary care and related services in geographic areas that are medically underserved. Community Health Centers, also known as Federally Qualified Health Centers (FQHC) or FQHC look-alikes, receive funds or meet the criteria for the federal Health Resources & Services Administration Health Center Program.

    • Results for Community Health Centers are anticipated in early 2019.

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  • How are the healthcare organizations rated?

    The Scorecard rates healthcare organizations using approximately 30 healthcare quality measures. To rate a healthcare organization, we calculate a performance score for each quality measure. A score is typically the percent of patients with a given type of insurance (commercial, Medicare or Medicaid) who received the type of care or outcome described in the quality measure. For each measure, we then compare the score for the healthcare quality measure to the statewide average and determine whether the healthcare organization’s level of performance for a given measure is below the state average, average, or above average. The quality care rating indicates if a healthcare organization scored below the state average, above the state average or similar to the state average.

    Quality Care Legend
    Above the state average
    Similar to the state average
    Below the state average
    Not rated due to data limitations (e.g., too few patients)

    For many measures, we also include the top performer or national scores as benchmarks for comparison. These serve as additional ways to compare the performance of one healthcare organization against the performance of others.

  • What methods are used to calculate a healthcare organization’s performance score and rating?

    Step 1: Obtain data

    The data used in the Scorecard come from two sources: patient surveys and health insurance claims.

    • Patient Surveys. The five measures for patient satisfaction are based on information from patients collected with the “Consumer Assessment of Healthcare Providers and Systems” survey, or “CAHPS.” Yale’s School of Public Health oversees the collection of CAHPS data from patients with commercial medical insurance coverage. The Connecticut Office of Health Strategy oversees the collection of CAHPS data from patients with Medicaid coverage. The Yale School of Public Health provides CAHPS results for inclusion in the Scorecard. The methods and full results are available upon request through Yale’s School of Public Health. Of note, healthcare payers in Connecticut determined the definition of the advanced networks and attribution rules. At times, these definitions differ from the attribution rules used for the Connecticut Scorecard measures that rely upon health insurance claims data.
    • Health Insurance Claims Data For the other healthcare quality measures, we calculate scores using administrative data related to health insurance claims. Claims data is the billing and other data that healthcare providers send to insurance companies and other healthcare payers in order to be paid for services rendered. We receive claims data from Connecticut’s All-Payer Claims Database (APCD) which is operated by Access Health CT, Connecticut’s Health Insurance Exchange. Most commercial payers and Medicare send claims data to the APCD. The state of Connecticut sends claims for employee-related claims but not Medicaid. Private employers that pay for the healthcare expenses of their employees directly, rather than buying an insurance policy (so-called self-funded plans), also do not currently submit data to the APCD. The datasets the APCD sends to us do not include patient names or social security numbers. The claims have a random individual patient number organized by individual patient, however, so all claims associated with an individual patient can be analyzed together.

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    Step 2: Select patients to include when rating a healthcare organization

    Attribution is the assignment of a patient to a healthcare provider who is accountable for the patient’s quality and cost of care. To attribute patients within the claims data, we first determine a patient’s primary care provider such as a physician, Advanced Practice Registered Nurse (APRN), or Physician Assistant (PA). If the patient saw more than one primary care provider within the past two years, we link the patient to the primary care provider that the patient has seen most often. Once a patient is attributed to a primary care provider, all the healthcare that the patient receives, even if delivered by another provider, is attributed to that primary care provider. We then assign the care delivered to the patient to the primary care provider’s healthcare organization.

    For the claims data Attribution Methodology click here. We invited the leadership of the healthcare organizations to verify lists of their healthcare providers and to provide feedback on our method for attribution.

    Step 3: Calculate the performance score

    We combine data from all of the patients whose care is attributed to a healthcare organization to calculate performance scores for each healthcare quality measure. The scores provided are specific to the type of health plan or insurance used to pay for the care delivered to patients. Therefore, based on payer type, a healthcare organization may have three performance scores for a quality measure: Commercial, Medicare and Medicaid. For the Scorecard, Commercial includes the APCD data from fully-insured health plans and the State of Connecticut’s self-funded health plan for state employees. This accounts for approximately x% of the CT population with a commercial health plan. The APCD does not include data from other self-funded plans where employers pay directly for employee healthcare expenses rather than buying an insurance policy.

    Each measure has technical specifications for calculating the score. Click here for the Measure Specifications.

    Step 4: Compare to benchmarks to determine rating

    Benchmarks are a way to compare the performance of one healthcare organization against the performance of others. For many measures, we include the state average along with the top performer or national scores as benchmarks for comparison. For each measure, we compare the performance score for the healthcare quality measure to the statewide average benchmark and determine whether the healthcare organization’s scores for a given measure is below the state average, average, or above average. The quality care rating indicates if a healthcare organization scored below the state average, above the state average or similar to the state average.

    Quality Care Legend
    Above the state average
    Similar to the state average
    Below the state average
    Not rated due to data limitations (e.g., too few patients)

    For the Benchmark, Rating, and Risk Adjustment overview click here. The Quality Council made drafts of this and other methods-related documents for the Scorecard available online for public comment.

  • How do stakeholders and others participate in the Scorecard?

    We invite the leadership of the healthcare organizations to verify lists of their healthcare providers and to provide feedback on our method for attribution. Rated healthcare organizations may also contact us if they believe there has been an error in attribution or score calculation.

    Other stakeholders participate in the scorecard development through their membership in the Quality Council. Members of the Quality Council include health care providers, health insurance experts, patient advocates and other experts from across the healthcare and related sectors in Connecticut.

    The general public may also participate in providing feedback about HealthQuality CT and the scorecard. Meetings of the Quality Council are generally open to the public and its meeting minutes are freely available online for public review. In addition, the Quality Council has made early drafts of several documents related to the Scorecard available online for public comment. Further, members of the general public are invited to contact us with technical concerns about the website.

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