Quality Improvement

The Health Plan is committed to providing our members with the highest quality of health care. NCQA accreditation for our HMO, Medicare and Medicaid products ensure we meet the set industry standards for quality throughout the organization. HEDIS and Stars, which measure Medicare quality, provide data that compares how we rank nationally and regionally. 

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.

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.