Commitment to Quality
Quality Improvement Program
We are committed to quality and to ensuring you get the best health care. We have created programs and services to meet the needs of our members and providers. Our quality improvement program is how we measure progress toward achieving the best care for our members. It looks at care, safety, and the services you get, so that we know where there are opportunities for improvement. This includes tests, shots and necessary care for diseases such as asthma, heart disease and diabetes.
- Our goal is to do better than what is expected from us.
- We track health care services you get through a survey of our doctors called HEDIS®.
- We ask how well we serve you through a member survey every year called CAHPS®.
- Appointment availability
- After-hours services
- How long patients wait in the office for an appointment
- Facility site reviews include looking at access for disabled people
- Making sure the network of doctors in your area fits your needs
- Member satisfaction surveys
- Doctor satisfaction surveys
- Quality of care studies to assure appropriate:
- Well child visits
- Cervical cancer screening
- Breast cancer screening
- Diabetes care
- Asthma care
- Cardiovascular care
- High blood pressure
- Prenatal and postpartum care
- Improve quality of care
- Monitor and improve patient safety
- Improve member satisfaction
- Ensure that care and communications are adjusted based on preferred language and cultural considerations
- Improve the delivery of care for People with complex health care needs
- Provide a network of high-quality providers and practitioners
- Monitor and improve behavioral health care
- Meet regulatory and other health plan requirements
- Monitor quality of care in long-term care nursing facilities
- Provide models of best care practices based on scientific evidence
We use a number of tools each year to help us determine how we’re doing. These include the Healthcare Effectiveness Data and Information Set (HEDIS®) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey.
HEDIS measures the quality of many types of care and service, and is used by nearly all American health plans. CAHPS is a survey that measures how happy members are with their doctors, their care and their health plan. We use these results to help us better our service.
Star ratings are used to compare Medicare Advantage and Prescription Drug Plans to help you make informed choices about your health care. Ratings focus on patient care and satisfaction, using national clinical and service-quality measures, health outcomes and patient feedback.