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Methods and Data Sources

How the Ratings are Calculated

Health plan ratings, shown as stars (One Check Out of Three Possible Checks), are assigned to each health plan for each indicator based on the plan's score for the indicator (for example, overall satisfaction with the plan). Scores are typically the percentage of members that received a service or answered a survey question with a particular response. The following methods were used to calculate a plan's rating.

First, all scores for specific indicators are grouped by product line (for example, Medicaid or commercial HMOs). Each plan's individual HEDIS measure scores are compared against the national means and percentiles of all health plans in the same product line. Where an individual score falls relative to the percentile rates determines the number of stars for that particular measure. For example, if a plan’s score for Adolescent Well-Care Visits is 66%, and the 50th percentile rate is 63%, then the plan would have a rating of 5 stars for this measure because its rate is above the 50th percentile rate.

Ratings for Quality of Care Indicators.

For each indicator, plans are assigned a rating as follows:

  • 5 Stars = at or above 50% of all health plans' scores in a line of business
  • 4 Stars = better than at least 40% of all health plans' scores in a line of business
  • 3 Stars = better than at least 25% of all health plans' scores in a line of business
  • 2 Stars = better than at least 10% of all health plans' scores in a line of business
  • 1 Stars = worse than 90% of all health plans' scores in a line of business

A rating of “N/A” means data were collected but cannot be displayed due to a lack of statistical significance. Failure to reach significance is usually due to a small number of members used to calculate a measure. “N/A” can also mean that some data items are not required for certain health plans or product lines. For example, data for "Well-Child Visits " are not required for Medicare HMO plans.

Quality of Care Indicators

Quality of Care Indicators measure the percentage of an eligible population who have received a specific health care service. For example, breast cancer screening is an indicator that reports the percentage of women who have received at least one mammogram in the past two years.

The indicators are based on definitions from the Healthcare Effectiveness Data and Information Set (HEDIS®), a registered trademark of the National Committee for Quality Assurance (NCQA). HEDIS is a set of measures that are used to report the performance of health plans. Health plans collect the data for a required set of preventive and chronic disease services and submit the indicators to AHCA each year by October 1st.

Member Satisfaction

Members of Florida Healthy Kids health plans were polled by the University of Florida's Survey Research Center via a telephone survey to obtain results for member satisfaction. Approximately 400 surveys were completed for each health plan. Adults were asked about their satisfaction with their personal health care. In a separate survey, a parent, family member or guardian was asked about their satisfaction with their child's care

Members of Florida Medicaid health plans were polled by National Committee for Quality Assurance (NCQA)-certified survey vendors contracted by each health plan. Surveys were conducted via mailed documents or telephone calls in the first half of each year. Approximately 411 surveys of adults were completed for each health plan serving adults, asking about their experiences with their personal health care. Approximately 411 surveys of parents were completed for each health plan serving children, asking about their experiences with their child’s care.

Members of commercial managed care and PPO insurance plans were polled by vendors contracted by each health plan. Surveys were conducted via telephone calls or mailed documents in the first half of each year. Approximately 400 surveys were completed for each health plan.

The survey instrument used, the Consumer Assessment of Healthcare Providers and Systems (CAHPS Health Plan Survey, version 5.0H), was developed jointly by the U.S. Agency for Healthcare Research and Quality (AHRQ) and the National Committee for Quality Assurance (NCQA).

Sources for the Data

Quality of Care Indicators: Data come from selected measures of the Healthcare Effectiveness Data and Information Set (HEDIS®), collected and submitted by each managed care health plan. Data are audited by an NCQA-Certified Auditor. Data for each measurement year are submitted to the Agency by July 1st for Medicaid managed care plans and by October 1st for Commercial and Medicare plans.

Member Satisfaction:  Data come from selected questions of the CAHPS Health Plan Survey, version 5.0H. Commercial (PPO and managed care) and Medicaid managed care plans collect and submit these data, usually administered by an NCQA-Certified Vendor. Members of Healthy Kids HMO plans are surveyed by the University of Florida's Survey Research Center. Survey data are submitted to the Agency by July 1st of each year.

Coverage Areas by County:  Coverage areas for commercial HMO and Medicare Advantage plans are provided by the Florida Office of Insurance Regulation. Coverage areas for Medicaid managed care plans are provided by the Agency. Coverage areas for Florida Healthy Kids HMOs are provided by the Florida Healthy Kids Corporation. The coverage area data are updated approximately quarterly.

Enrollment by Health Plan:  Enrollment data are provided by the Florida Office of Insurance Regulation (commercial, Medicare and Healthy Kids), and the Agency for Health Care Administration (Medicaid). The enrollment data are updated approximately quarterly.

Financial Performance Indicators:  Data can be viewed by visiting the National Association of Insurance Commissioners (NAIC) website, at https://eapps.naic.org/cis/.

Health Plan Premium Rates:  Data can be viewed by visiting the Florida Office of Insurance Regulation website, at https://choices.fldfs.com/landh/SmallGroup?_ga=1.117890633.1792348441.1420648500. Data for premium rates are updated daily.


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