Health plan (HMO, PPO, etc.)

QualityTools 05/08/14

This Web site helps uninsured and underinsured consumers in California navigate the application process for discounted care from hospitals. It also provides information about health insurance plans and pricing to protect against medical debt and underinsurance through policy change, public education, and legal assistance.

The Web site includes shared stories, an insurance calculator, and information in Spanish.

FAIR Health Consumer Cost Lookup 05/08/14

FAIR Health Consumer Cost Lookup is a free tool that consumers can use to get an estimate of how much health care providers charge for medical and dental services in their area. It will also inform consumers how much of that cost they can expect their insurer to cover if they have to go out-of-network for care.

In addition to the Lookup tool, the Web site provides educational articles and videos about the health care insurance reimbursement system.

MONAHRQ® 4.0 09/18/12

My Own Network, powered by AHRQ (MONAHRQ), is a free software product that enables organizations—such as State and local data organizations, chartered value exchanges, hospital systems, and health plans—to input their own hospital administrative data and generate a data-driven Web site. MONAHRQ software analyzes, summarizes, and presents information in a format ready for use by consumers and other decisionmakers on:

  • Quality of care at the hospital level.
  • Health care...
Improving Outcomes for Children in Child Welfare: A Medicaid Managed Care Toolkit 04/25/12

This toolkit, developed by the Center for Health Care Strategies (CHCS), can help guide efforts to improve care for children in the child welfare system. The toolkit presents the work of 9 managed care organizations that participated in a 3-year CHCS quality improvement collaborative. It provides details about the pilot efforts of each plan, including identification, stratification and outreach strategies developed, as well as obstacles faced and preliminary outcomes achieved.


Improving Asthma Care for Children Toolkit: Best Practices in Medicaid Managed Care 03/30/10

This toolkit provides strategies to improve asthma care tested by a diverse group of health plans serving Medicaid consumers. The inventive methods, targeted for children with asthma, can also be used for adults. The toolkit suggests the need for collaborative approaches and documentation to support further investments for the following techniques:

  • Developing and creatively using asthma registries
  • Using innovative methods to reach high-risk members
  • ...
Improving Medicaid Managed Care for Youth with Serious Behavioral Health Needs: A Quality Improvement Toolkit 03/04/10

This toolkit is designed primarily for managed care organizations that want to improve administrative and clinical practices that support the delivery of services to children and youth with serious behavioral health needs, as well as their families. In addition, purchasers of managed care services for this population can use the toolkit to identify promising approaches for their managed behavioral health care programs. Providers can also learn from the initiatives described, and implement...

Designing and Implementing Medicaid Care Management Programs: A User's Guide 05/30/08

The Medicaid Care Management Guide helps States design, implement, and evaluate care management programs for the chronically ill. The guide addresses five stages of care management program development, supplemented by three key topics that should be considered at every development stage.

The guide includes information on the following topics:

  • Planning a care management program
  • Engaging stakeholders in a care management program
  • Selecting and...
Consumer Financial Incentives: A Decision Guide for Purchasers 03/19/08

Consumer Financial Incentives: A Decision Guide for Purchasers is designed for health plans, State Medicaid agencies, and employers who are considering implementing a consumer financial incentives program. The guide is intended as a tool for exploring if and how consumer financial incentives might be tapped to improve community or market readiness for quality improvement. Incentives can be applied to a range of consumer decisions that purchasers may seek to influence in the pursuit of a high...

New York Regional Health Care Report Card 03/19/08

This online report allows health care consumers to compare the cost and quality of commercial health insurance plans by county in New York and New Jersey. Additionally, consumers have access to information regarding the quality of care, mortality rates, length of stay, and pricing of care received by the plans members.

HMO report cards are available for years 2000 to 2004, 2006, and 2007. The individual report’s detailed results include each HMO’s actual score and State and national...

Achieving Better Care for Asthma: A Best Clinical and Administrative Practices Toolkit for Medicaid Health Plans 12/17/07

This 79-page toolkit from the Center for Health Care Strategies offers a structured approach for addressing quality improvement in asthma care for health plans serving Medicaid members. This toolkit offers practical approaches for identifying common barriers to achieving better care for members with asthma, developing strategies to overcome these barriers, reviewing clinical and administrative strategies that other health plans have implemented, and measuring incremental and long-term change...


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