Quality Improvement

Every year, our quality improvement program finds ways to help our members improve their health. We are committed to providing our members with the highest quality of health care. You can request a copy of our quality improvement program report to learn how we are improving care and services for members. You’ll also see the progress we are making toward our quality improvement goals.

Your satisfaction is our main focus. We review NCQA accreditation for our HMO, Medicare and Medicaid products to ensure we meet the industry standards for quality throughout our organization. HEDIS and Stars, which measure Medicare quality, provide data that compares how we rank nationally and regionally. We are continuously monitoring standards to see how long it takes our members to get needed care with appointments and after-hours care. We monitor phone calls to make sure a member's needs are met quickly and effectively. We also review complaints from our members.

NCQA

The National Committee for Quality Assurance (NCQA) is a private, non-profit organization dedicated to improving health care quality. NCQA Health Plan Accreditation evaluates how well a health plan manages all parts of its delivery system – physicians, hospitals, other providers and administrative services – in order to continuously improve the quality of care and services provided to its members. The standards are purposely set high to encourage health plans to continuously enhance their quality.

To learn more about health plan accreditation, visit NCQA.org.

HEDIS

Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures developed by the National Committee for Quality Assurance (NCQA). The information gathered during HEDIS reviews is used to compare the performance of managed care plans nationally.

To learn more about HEDIS, visit NCQA.org.

CAHPS

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys are an opportunity for our COmmercial and Medicaid members to report their care experience. Through mail or telephone, a random confidential sample of our members answers a standardized set of questions about patient experience and access to care. 

HOS

The Medicare Health Outcomes Survey (HOS) is a confidential patient-reported outcome measure used in Medicare managed care. It covers physical functioning, the role that physical health plays in their lifestyle, bodily pain, general health, vitality, social function, and mental and emotional health.

Star Ratings

The Centers for Medicare and Medicaid Services (CMS) uses a five-star rating system to measure the performance of Medicare Advantage and Part D plans. A plan’s overall star rating is determined by health services such as screenings and vaccines, managing chronic conditions, member experience, member complaints, and customer service. Star ratings are released annually.