CHP among “America’s Best Health Insurance Plans 2009-10,” top health plan in Florida

TALLAHASSEE, Fl. - Capital Health Plan (CHP) has once again received national acknowledgement. CHP is ranked 5th in the nation for both Commercial and Medicare health plans. In the 2009-10 America’s Best Health Insurance Plans rankings published by U.S.News & World Report and the National Committee for Quality Assurance (NCQA), CHP is also the top-ranked plan in Florida. This is the highest combined ranking CHP has ever achieved.

“We are very pleased with this recognition which reflects a lot of outstanding work by our staff and this medical community. This also would not be possible without great support year after year from our members and area employers,” said John Hogan, CEO of Capital Health Plan. “This type of feedback is great news for Tallahassee and only furthers CHP’s dedication to delivering high quality, affordable health care and service to our community.”

As part of its commitment to excellence, CHP continues to focus on three primary strategic initiatives:

• Improving the health of the population
• Enhancing the patient experience of care (including quality, access, and reliability)
• Controlling trends in the per capita cost of care

John Hogan reflects, “We have a lot to accomplish in all three areas as does our nation, but Tallahassee definitely stands out in these efforts.”

NCQA’s Quality Compass database also reported high ratings for Capital Health Plan. The scores of commercial health plans are voluntarily reported NCQA using data from HEDIS® and CAHPS® measures in categories related to access to care, overall satisfaction, prevention and treatment. These scores reflect the results of consumer surveys and success in preventing and treating illness compared to other plans.

Commercial Ratings:

• CHP members rated their satisfaction with their personal doctor (rating of 9 or 10) as the highest in the state.
• CHP members once again scored the Plan the highest in the state and the South Atlantic Region when asked “how satisfied are you with your health plan?”
• CHP scored the very highest in the nation for Spirometry Testing for COPD.

Medicare Ratings:

• CHP scored the very highest in the nation for Diabetic eye exams.
• CHP scored the very highest in the nation for Colorectal cancer screenings for the 5th year in a row.
• CHP scored the very highest in the nation for Spirometry Testing for COPD.

The 2009-10 “America’s Best Health Insurance Plans” rankings are published online at www.usnews.com/healthplans, and will be featured in the December 2009 issue of U.S. News, which will be on newsstands Tuesday, December 1.

“America’s Best Health Insurance Plans” is a trademark of U.S. News & World Report. HEDIS® stands for Healthcare Effectiveness Data and Information Set and is a registered trademark of the National Committee for Quality Assurance (NCQA).

The source for data contained in this publication is Quality Compass® 2009 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass 2009 includes certain CAHPS data. Any data display, analysis, interpretation, or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such display, analysis, interpretation, or conclusion. Quality Compass is a registered trademark of NCQA. CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

Nancy Van Vessem, MD

Chief Medical Officer

Everyone who is part of the CHP network wants patients to have good clinical outcomes. The crucial first step for any medical problem is talking to the patient, and the second step is examining the patient. The easiest way to get off on the wrong track is to skip or short-cut these essentials.

While technology has helped in the diagnostic process, all technology has limitations and needs to be considered in light of the first two steps or, specifically, what the patient is experiencing.

A suggestion often seen on a report of a CT scan, x-ray, or MRI is that the ordering physician correlate (compare to see if it makes sense) the imaging findings with the clinical situation of the patient. The reason this is such a good idea is that oftentimes abnormalities are seen on imaging studies that have nothing to do with the patient’s symptoms, or the imaging study cannot be used to make a definite diagnosis. Let’s look at some examples.

Knee Pain: An article published in the New England Journal of Medicine in September, 2008, showed that when knee MRIs were done in middle-aged and elderly persons, a cartilage tear was found in 63% of people with knee pain, BUT 60% of people in the same age group without knee pain also had a cartilage tear. The take-home message? Just because you have a cartilage tear doesn’t mean it has anything to do with your knee pain. Clinical correlation is the key.

Multiple Sclerosis: A study, published in the British Medical Journal in 2006, compiled the results from 29 previous clinical studies that assessed MRI results along with patient outcomes. Its findings were that, with a first episode of a neurological symptom, MRIs had “limited utility for both ruling in and ruling out multiple sclerosis.” The most important information came from the clinical course of the patient. With regard to multiple sclerosis, a second episode of neurological symptoms occurring at least a month after the first episode is necessary to make the diagnosis.

Low Back Pain: Low back MRIs (noted in the back pain article) are another example of how imaging studies can potentially lead down a path of treatment that may not yield good clinical results: “65 out of 100 adults without any back pain have abnormalities such as arthritis and bulging discs.” These imaging results make early clinical correlation problematic and can lead to inaccurate associations between chronic asymptomatic findings and acute pain.

COPD: The final example is Chronic Obstructive Pulmonary Disease (COPD), also called chronic bronchitis and emphysema. If COPD becomes severe, changes may appear on a chest x-ray, but for mild and moderate cases, the chest x-ray can easily appear normal. The way to diagnosis COPD is, once again, the duration of the patient’s symptoms, such as cough, along with pulmonary function testing (PFT) to measure the function of the lungs, rather than viewing the anatomy of the lungs. So the next time you hear from someone who smokes that they are fine because their chest x-ray is normal, ask them if they have had the appropriate history and testing that diagnoses COPD. As with many medical conditions, earlier diagnosis of COPD leads to more treatment options. Not being able to breathe is a bad outcome.

It’s not that there is anything wrong with images; it’s just that a picture doesn’t tell the patient’s story. Patients have to do that, and the best place to start is with your primary care physician. The last thing that anyone wants is to treat a radiological abnormality but end up with no relief from an underlying medical condition because the image told a different story. Remember, too, that keeping track of your symptoms in a diary—knowing the details of what you are experiencing—is invaluable to getting to the right next step.