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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:
- Clinical quality surveys
- Member satisfaction surveys
- NCQA surveys
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 scroll through the page to see our latest HEDIS results.
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 call Member Services to learn more. Just call 1-888-348-2922 (TTY: 711).
Recap of 2023 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.
A tool called HEDIS® (Healthcare Effectiveness, Data and Information Set) helps us measure if our members are getting good health care.
Here are some of the 2023 HEDIS® Results:
We met our goal of year-over-year improvement in these areas:
- Lead screening in children
- Childhood nutrition counseling
- Annual dental visits
- Blood pressure control in people with diabetes
- Blood pressure control in people with hypertension
- Hemoglobin A1C control in people with diabetes
- Postpartum care visits
- Breast cancer screening
We did not meet our goal of year-over-year improvement for:
- Adolescent immunizations
- Childhood immunizations
- Cervical cancer screening
- Eye exams for people with diabetes
- Early prenatal care visits
- Follow-up after hospitalization for mental illness
Member Satisfaction Results
We also conduct a member satisfaction survey each year. The survey is called CAHPS®. There is 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 2023 CAHPS Survey Results
Areas where we met our goals:
- Getting Care Quickly (adult survey)
- Getting Needed Care (both surveys)
- Rating of Personal Doctor (adult survey)
- Rating of Health Care (adult survey)
- Coordination of care (adult survey)
- Customer Service (adult survey)
Areas where we did not meet our goals:
- Getting Care Quickly (child survey)
- Rating of Personal Doctor (child survey)
- Specialist Doctor (both surveys)
- Rating of Health Care (child survey)
- Rating of Specialist Doctor (both surveys)
- Coordination of Care (child survey)
- Customer Service (child survey)
We will continue to work hard to make sure you get the best health care and service!
Your voice matters!
If you get a member satisfaction survey, please take the time to complete it. We do our best to earn the highest scores (9 or 10) from our members. If you are not happy with your health care or service, please let us know. Call Member Services at 1-888-348-2922 (TTY: 711).
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)
These are just some of our quality services. To learn more about them, call Member Services at 1-888-348-2922 (TTY: 711). You can also ask for a written description of our Quality Improvement Program.
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).