Member Resources

Quality Highlights

Our Quality Improvement Program (QIP) supports our mission to deliver direct access to high-value, personalized health care that aims to improve your health and well-being through all your health care needs. The QIP drives organizational improvement for excellence through efficiencies, increasing the competitive advantage, and building trust and recognition in the community to improve the health status, safety, and satisfaction of our members.

The QIP is the framework for a formal process to assess and monitor our performance through a systematic approach of monitoring and evaluating the quality and effectiveness of care for our members. This approach enables us to focus on issues of appropriateness, efficiency, safety, as well as health outcomes and satisfaction of our members and their providers. This is achieved by continuous monitoring of our performance according to, or in comparison with, objective measurable performance standards. The QIP promotes accountability and assures identification and evaluation of issues that impact our ability to better our performance and improve health care and administrative services provided to our customers.

We annually review our QIP structure and develop a work plan to define quality-related planning and monitoring of activities as well as clinical and operational improvement. We also continuously evaluate our activities, analyze progress toward our goals, and identify new focus areas and goals. Our Quality Program is evaluated annually to make sure it is effective and meaningful, and that it meets regulatory standards and guidelines.

Quality Improvement Program Description 2022

Quality Improvement Program Work Plan 2022

Medicare Star Ratings*

The Medicare Program rates all health and prescription drug plans each year, based on a plan’s quality and performance.** Medicare Star Ratings help you know how well our plan is doing. Star Ratings are based on five health service categories:

  1. Keeping members healthy through preventive screenings, vaccines, and other checkups
  2. Managing chronic (long-term) conditions
  3. Member satisfaction with their health plan, drug plan and provider
  4. Operational performance
  5. How well plans handle customer requests

*Star Ratings are based on 5 Stars. Star Ratings are assessed each year and may change from one year to the next.
**Health and prescription drug plans must meet a minimum measure threshold to receive a Medicare Star Rating.

How can you help?

  • Schedule an Annual Wellness visit every year
  • Receive your screenings and preventive care, including your flu shot and vaccines
  • Complete and return all member surveys
  • Discuss and monitor your physical and mental health with your doctor
  • Work with your doctor or pharmacy to stay up-to-date on your medications

H6874_11281_092021
05/2022