Dept. of Health Services: State quality initiative improving HMO services to Medicaid members

Contact: Beth Kaplan

(608) 267-3810

HMOs Meet Nearly 90% of State Quality Goals

MADISON — The quality of health care services provided by Health Maintenance Organizations (HMOs) to Wisconsin Medicaid members in 2009 improved over both 2008 and 2007 levels, according to the results of a new Pay-For-Performance initiative started by the Department of Health Services (DHS) last year. The 13 HMOs, serving more than 630,000 Medicaid members, met nearly 90 percent of their quality goals.

“The goal of this initiative is to ensure that state Medicaid members get the highest quality, most cost effective health care services,” said Wisconsin Medicaid Director Jason Helgerson. “We also want to give our members the tools to make the best choices for themselves and their families.”

Today DHS launched an interactive website to help Medicaid members select an HMO by providing the latest data and quality scores for their HMO options, Currently, state Medicaid members are mailed the HMO Report Card, which shows letter grades earned by each HMO based on comparisons with national and Wisconsin average quality scores, once every year. Beginning today current members and new enrollees can access the quality data online and can search by specific health condition.

HMOs can receive incentive payments if they meet all of the quality goals. Four HMOs, Dean Health Plan, Group Health Cooperative of South Central Wisconsin, Security Health plans and Unity Health Plan, will receive more than $1.2 million in pay for performance incentive payments based on their performance in 2009.