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Quality matters

You deserve to get the highest quality care. So we work with your provider to make sure that happens. Together, we're committed to giving you the best health care experience possible.

 

Questions?

Just contact us. We’re here to help. 

Providing you with quality service

Providing you with quality service

Making sure you get the highest quality care when you need it is our goal. We partner with local providers who understand your needs. And the National Committee for Quality Assurance (NCQA) continues to accredit us. This is because we score high on:

 

Healthcare Effectiveness Data and Information Set (HEDIS®) scores

We want to improve access to quality health care for our members. You have a large network of providers to help you reach your health goals. This includes: 

 

  • Obstetrician/gynecologists (Ob/Gyns)
  • Pediatricians
  • Top hospitals
  • Community groups

HEDIS scores help us make sure we’re meeting our goals. You can see our latest HEDIS results on this page. You can also learn more about HEDIS on the NCQA website.

 

 NCQA website

Member satisfaction surveys

 

Your answers on our Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys are private. We use the results to improve the way we take care of our members. You can see our survey results on this page. Or you can contact us to learn more.

Recap of 2020 HEDIS and CAHPS results

 

We work hard to make sure you get the best health care and service. Each year, we look at how well we are doing. We set goals for care and service. If we don’t reach our goals, we make a plan to help us improve and reach our goals in the future.

 

Here are some of the 2020 HEDIS results:

 

Areas where we met our goals include:

 

  • Depression medication adherence 
  • Treatment for substance use disorder 
  • Follow-up after ADHD diagnosis 
  • First-line care for youth who receive anti-psychotic medications 
  • Testing and care for sore throat 
  • Avoiding continued opioid use 
  • Steroid or bronchodilator after hospitalization for COPD 
  •  

Areas where we did not meet our goals include:

 

  • Child and teen immunizations 
  • Preventive screenings for women 
  • Blood pressure and glucose control for diabetics 
  • Appropriate antibiotic use for bronchitis/bronchiolitis or colds
  •  

Areas where we did not meet our goals but improved over last year include:

 

  • Controlling blood pressure 
  • Diabetic retinal eye exams 
  • Follow-up after hospitalization for substance use disorder 
  • Follow-up after hospitalization for mental illness 
  • Cholesterol medication adherence for members with heart disease 
  • Medication therapy for opioid use disorder 
  •  

We also conduct a member satisfaction survey each year. The survey is called CAHPS®. It includes an adult survey and a child survey. The results from the survey help us:

 

  • Get feedback from members 
  • Learn more about our members’ needs 
  • Compare our service to other health care plans 
  • Find ways to improve
  •  

Here are some of the 2020 CAHPS survey results:

 

Areas where we met our goals include:

 

  • Rating of child’s specialist doctor 
  • Rating of all health care for children 
  • Coordination care among adult members’ doctors 
  •  

Areas where we did not meet our goals include:

 

  • Getting care quickly
  •  

Areas where we did not meet our goals but improved over last year include:

 

  • Rating of child’s personal doctor 
  • Rating of all health care for adults

Your voice matters

 

If you get a member satisfaction survey, be sure to take the time to complete it. We do our best to earn the highest scores (9 or 10) from our members. If you’re not happy with your health care or service, we want to know. Just call us: 

 

 

Our goals and objectives

Our goals and objectives

The Quality Improvement Program includes these goals:

 

  • Promote and build quality into the daily operations and policies of the health plan.
  • Continually check and assess your needs, care and services to ensure you’re getting quality care at the right time.
  • Find areas for improvement and act on them.
  • Encourage patient safety through seasonal communications to you (for example, flu mailers).
  • Ensure we meet or exceed the highest quality by following local, state and federal regulatory requirements and accreditation standards.
  • Provide support for the things that affect health, like rides, food and housing support.

Our services

Our services

The program provides many services, which include:

 

  • Offering extra benefits to encourage wellness, including a preventive care rewards program
  • Sending you helpful postcards and newsletters about your health
  • Reviewing primary care provider offices to make sure they meet state standards
  • Reviewing the quality of our services
  • Reminding you and your provider about preventive health care
  • Measuring your satisfaction with your provider and health care services
  • Scanning phone calls to ensure that we answer your call quickly and that you get the correct info
  • Working with your providers to ensure they get all the info they need from us to provide you with quality care
  • Offering health programs, including info about chronic illnesses and one-on-one support for social determinants of health (conditions in the places where you live, learn, work and play that affect your health)

Reviewing new treatments and care

Reviewing new treatments and care

To ensure you get the highest quality care, we review the latest medical changes. This includes changes to:

 

  • Physical health treatment and services
  • Behavioral health treatment and services
  • Medicines
  • Equipment
  • Dental care

After reviewing the updated research, we decide if these changes:

 

  • Are safe and helpful
  • Offer the same or better results than our current practices

This helps us to decide whether to add new treatments or care to your benefits.

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

Also of interest: