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Measuring the difference

Vera Whole Health and Castlight Health are now apree health

Measuring the difference

Vera Whole Health and Castlight Health are now apree health

author Marla McLaughlin, MD

In healthcare, there are several ways to measure results, ranging from the micro (a person is treated, they get better) to the macro (how the industry as a whole is performing).

Between these two poles is the Healthcare Effectiveness and Data Information Set, or HEDIS, which is a standardized set of more than 90 measurements across these six domains of care:

  1. 1. The effectiveness of care, such as prevention and screening, respiratory and cardiovascular conditions, diabetes, behavioral health, and more. 
  2. 2. Access/availability of care, including prevention and ambulatory health services, dental visits, substance use disorder treatment, prenatal and postpartum care, and first-line psychosocial care for children and adolescents.
  3. 3. Experience of care, how a patient interacts with care and receives treatment.
  4. 4. Utilization and risk-adjusted utilization, which measures care like child and adolescent well-care visits, frequency of selected procedures, mental health utilization, and  complicated care like acute hospital utilization and emergency visits.
  5. 5. Health plan descriptive information or the accessibility of health plan information for a patient.
  6. 6. Measures reported using electronic clinical data systems, meaning the capture of information on procedures like breast cancer screenings, follow-up care for children prescribed ADHD medication, and unhealthy alcohol use screenings and follow-ups.

HEDIS was defined by the National Coalition for Quality Assurance (NCQA), and is one of healthcare’s most widely used performance improvement tools. The goal is to compare quality of care happening at clinics nationwide.

How HEDIS works

Used by more than 90 percent of U.S. health plans, HEDIS data is collected via surveys directly from health plans and Preferred Provider Organizations (PPOs). 

Results are then compared and participants can see how they measure up in their chosen metrics.

For example, if a healthcare organization has a result in, say, the 95th percentile in controlling high blood pressure, they are performing better in that metric than 95 percent of the clinics in the country.

How we measure up

At apree health, we track seven HEDIS metrics that we feel are a good representation of the tenets of advanced primary care (APC) — our specialty. These metrics are a mix of preventive care (cancer screens), chronic disease management (hypertension, diabetes), and mental health.

In 2023, we’re proud to say that our individual care center metrics were extremely high. Here’s how it breaks down:

  • More than 50% percent of our care center metrics were in the 95th percentile
  • More than 70% were in the 90th percentile
  • More than 83% were in the 75th percentile

While these results are impressive, they are just a fraction of what is happening at our care centers nationwide. 

All credit goes to our dedicated care center and centralized services teams who provide access, ask the right questions, and cover all necessary care gaps no matter the reason for a patient’s appointment. These are the tenets of APC, and we’re performing at the highest level.

Still, HEDIS is just one important measurement.  Another is how satisfied patients are with their care, which is where the net promoter score (NPS) comes in.

How NPS works

The backbone of NPS is a deceptively simple equation. On one end, you have the percentage of patients who are promoters or happy with their quality of care. On the other end is the percentage of detractors or those who are unsatisfied.

When the percentage of detractors is subtracted from the percentage of promoters, you arrive at a number that lands between -100 and +100.

The goal, of course, is to be on the positive side of this scale. Scores above 30-40 are considered strong in the healthcare industry, with 34 being the industry average.

How we measure up

Our APC model dramatically exceeds the industry average with our latest NPS score hitting +86.

This 52-point gap above the industry average shows that the foundations of APC — managing the whole health of the patient, improving navigation to increase involvement, and so on — are not just working to increase patient satisfaction.  Our patients are also feeling better and recognizing a dramatic improvement in the quality of the care they receive.

For an example of how this score translates into real world results, let’s talk about Ken Cherry, one of our members whose life was changed by visiting one of our clinics at his work location. A quick summary:

During a visit with one of our primary care providers for a sore on his foot, Kevin did not want to disclose his diabetes because he knew his blood sugars were not in good shape, and he didn’t want to be “scolded.” In fact, the opposite happened. 

After being referred to a high-quality specialist, Ken learned he had three blockages in his leg and that his foot was infected to the bone due to his diabetes preventing his body from healing. Ken received treatment for his physical ailments, and he believes the care saved his life. 

He was also extremely thankful — and relieved — that his providers took the time to really listen to his concerns and helped him understand what was happening and how he could fix it by addressing his diabetes with whole person APC. As he puts it, “I’m convinced that because of [his provider’s] intervention, she saved my life. But more than that, she not only saved me, she changed the quality of what was going on with me to help me improve.”

You can hear Ken’s full story in the video below. And if you want to learn more about how APC benefits both patients and providers, check out our post explaining the basics of our model and how it’s transforming the healthcare industry.

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