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Have a question?
Just call Member Services at 1-855-232-3596 (TTY: 711). We’re here for you 24 hours a day, 7 days a week.
Just call Member Services at 1-855-232-3596 (TTY: 711). We’re here for you 24 hours a day, 7 days a week.
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
Healthcare Effectiveness Data and Information Set (HEDIS®) scores
We want to improve access to quality health care for our members.
We want to improve access to quality health care for our members. You have a large network of providers to help you be as healthy as you can be. This includes:
- Obstetrician/gynecologists (Ob/Gyns)
- Pediatricians
- Top hospitals
- Community groups
HEDIS scores help us make sure we’re meeting our goals.
What is HEDIS?
HEDIS is one of health care’s most widely used performance improvement tools. HEDIS measurement allows consumers to compare health plan performance to other plans and to national or regional benchmarks. We use these measurements to evaluate the quality of the care and services given to our members and to track year-to-year performance. HEDIS is one component of NCQA's accreditation process required by state regulators.
HEDIS measures
HEDIS includes more than 90 measures across 6 areas of care, including
- Effectiveness of care
- Access/availability of care
- Experience of care
- Utilization and risk adjusted utilization
- Health plan descriptive information
- Measures reported using electronic clinical data systems
You can find our HEDIS scores and compare with other health plans on the National Committee for Quality Assurance (NCQA) website.
Member satisfaction surveys
We want you to be happy with our services and the care you receive from our providers. We use surveys to ask members (or in some cases, their families) about their experiences with health care services in different settings. We use the results of those surveys to improve the ways we take care of our members.
The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey
The CAHPS survey is what we use to collect data about our members’ experience. This survey asks questions that focus on matters that our members find important. It tells us how they rank our health plan, our operations, our healthcare providers, including doctors, hospitals, physician practices and other healthcare providers and facilities.
CAHPS also asks about experiences with other aspects of health care, including getting needed care, getting care quickly, how well doctors communicate, health plan customer service and rating of health plan.
The CAHPS survey is another component of NCQA's accreditation process required by state regulators. NCQA publishes Health Plan Ratings each year. They rate all the health plans on a scale of 0 to 5 (0 is lowest) in .5 increments. You can find our ranking and other health plans on the NCQA website.
Note: Your answers on our CAHPS surveys are private. You can learn more about CAHPS on the NCQA website. Or you can contact us.
You can also learn more about HEDIS on the NCQA website.
Our goals and objectives
Our goals and objectives
The Quality Improvement program includes these goals:
- To promote and build quality into the daily operations and policies of the health plan
- To continually check and assess your needs, care and services to ensure you’re getting quality care at the right time
- To find areas for improvement and act on them
- To encourage patient safety through seasonal communications to you (for example, flu mailers)
- To ensure we meet or exceed the highest quality by following local, state and federal regulatory requirements and accreditation standards
- To 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 physician (PCP) and ob/gyn 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
- Reviewing the quality of our services
- Offering population health services, 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)
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).