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How We Rate
Healthcare Effectiveness and Data Information Set (HEDIS®) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®)
Network Health evaluates the quality of care and services provided to members using two nationally-recognized tools, the Healthcare Effectiveness and Data Information Set (HEDIS®) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®).
Each tool scores our services in a different way. HEDIS measures preventive care and our care for chronic diseases. CAHPS evaluates customer satisfaction with services provided by customer service, claims and physicians. The following tables highlight our 2018 results and show the excellent ratings of Network Health’s Medicare Advantage PPO plans.
Key
5 - Higher Performance
4
3
2
1 - Lower Performance
NA - Not Applicable
Consumer Satisfaction (Score - 3.5)
| Plan Details | Score |
|---|---|
| Getting Care | 4.5 |
| Getting Care Easily | 5 |
| Getting Care Quickly | 4 |
| Satisfaction with Physicians | 3.5 |
| Rating of Primary Care Doctor | 3 |
| Rating of Specialists | 3 |
| Rating of Care | 3 |
| Coordination of Care | 5 |
| Satisfaction with Health Plan Services | 3 |
| Rating of Health Plan | 3 |
Prevention (Score - 3.5)
| Plan Details | Score |
|---|---|
| Breast Cancer Screening | 4 |
| Colorectal Cancer Screening | 3 |
| Flu Shots | 3 |
| Pneumonia Shots | 4 |
Treatment (Score - 4)
| Plan Details | Score |
|---|---|
| Diabetes | 3.5 |
| Blood Pressure Control (140/90) | 4 |
| Eye Exams | 3 |
| Glucose Control | 3 |
| Patients with Diabetes - Recieved Statin Therapy | 4 |
| Patients with Diabetes - Statin Adherance | 2 |
| Heart Disease | 4 |
| Patients with Cardiovascular Disease - Recieved Statin Therapy | 3 |
| Patients with Cardiovascular Disease - Statin Adherance | 3 |
| Beta Blocker After Heart Attack | 3 |
| Controlling High Blood Pressure | 5 |
| Smoking Advice | NA |
| Mental and Behavioral Health | 3.5 |
| Depression: Adhering to medication for 6 months | 5 |
| Follow-Up After Hospitalization for Mental Illness | 3 |
| Alcohol or Drug Dependence Treatment Initiated | 3 |
| Other Treatment Measures | |
| Observed-to-Expected Hospital Readmissions | 5 |
| Managing Risk of Falls | 2 |
| Avoiding Harmful Drug and Disease Interactions | 4 |
| Steriod After Hospitalization for Acute COPD | 4 |
| Testing for Osteoporosis | 4 |
| Managing Osteoporosis in Women After a Fracture | 1 |
| Avoiding High-Risk Medications | 5 |
| Non-Recommended Prostate Cancer Screening in Older Men | 4 |
The source for data reported above is Quality Compass© and is used with the permission of the National Committee for Quality Assurance (NCQA). Any analysis, interpretation, or conclusion based on the data is solely that of the authors, and NCQA specifically disclaims any responsibility for any such analysis, interpretation, or conclusion. Quality Compass is a trademark of NCQA.
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).
Star Ratings Information
The Centers for Medicare and Medicaid Services (CMS) uses a five-star quality rating system to measure Medicare patients' experiences with their health plans and the health care system. This rating system applies to Medicare Advantage (MA) plans. Our members appreciate our service and coverage—that’s why 90 percent stayed with us last year.* And CMS (the government agency that oversees Medicare) rates us 4 out of 5 stars.**
Network Health Medicare PPO Star Ratings for 2019 are listed in the tables below.
Key
5 - Higher Performance
4
3
2
1 - Lower Performance
NA - Not Applicable
HD1: Staying Healthy: Screenings, Tests and Vaccines
| Measure | Rating |
| C01: Breast Cancer Screening | 4 |
| C02: Colorectal Cancer Screening | 3 |
| C03: Annual Flu Vaccine | 4 |
| C04: Improving or Maintaining Physical Health | 2 |
| C05: Improving or Maintaining Mental Health | 3 |
| C06: Monitoring Physical Activity | 3 |
| C07: Adult BMI Assessment | 4 |
HD2: Managing Chronic (Long Term) Conditions
| Measure | Rating |
| C08: Special Needs Plan (SNP) Care Management | 3 |
| C09: Care for Older Adults - Medication Review | 5 |
| C10: Care for Older Adults - Functional Status Assessment | 5 |
| C11: Care for Older Adults - Pain Assessment | 4 |
| C12: Osteoporosis Management in Women who had a Fracture | 1 |
| C13: Diabetes Care - Eye Exam | 4 |
| C14: Diabetes Care - Kidney Disease Monitoring | 4 |
| C15: Diabetes Care - Blood Sugar Controlled | 4 |
| C16: Controlling Blood Pressure | 5 |
| C17: Rheumatoid Arthritis Management | 4 |
| C18: Reducing the Risk of Falling | 2 |
| C19: Improving Bladder Control | 3 |
| C20: Medication Reconciliation Post-Discharge | 4 |
| C21: Plan All-Cause Readmissions | 4 |
| C22: Statin Therapy for Patients with Cardiovascular Disease | 3 |
HD3: Member Experience with Health Plan
| Measure | Rating |
| C23: Getting Needed Care | 4 |
| C24: Getting Appointments and Care Quickly | 5 |
| C25: Customer Service | 4 |
| C26: Rating of Health Care Quality | 3 |
| C27: Rating of Health Plan | 4 |
| C28: Care Coordination | 5 |
HD4: Member Complaints and Changes in the Health Plans Performance
| Measure | Rating |
| C29: Complaints about the Health Plan | 5 |
| C30: Members Choosing to Leave the Plan | 4 |
| C31: Health Plan Quality Improvement | 2 |
HD5: Health Plan Customer Service
| Measure | Rating |
| C32: Plan Meets Timely Decisions about Appeals | 4 |
| C33: Reviewing Appeals Decisions | 2 |
| C34: Call Center - Foreign Language Interpreter and TTY Availability | 4 |
DD1: Drug Plan Customer Service
| Measure | Rating |
| D01: Call Center - Foreign Language Interpreter and TTY Availability | 5 |
| D02: Appeals Auto-Forward | 5 |
| D03: Appeals Upheld | 5 |
DD2: Member Complaints and Changes in the Drug Plan's Performance
| Measure | Rating |
| D04: Complaints about the Drug Plan | 5 |
| D05: Members Choosing to Leave the Plan | 4 |
| D06: Drug Plan Quality Improvement | 5 |
DD3: Member Experience with the Drug Plan
| Measure | Rating |
| D07: Rating of Drug Plan | 3 |
| D08: Getting Needed Prescription Drugs | 4 |
DD4: Drug Safety and Accuracy of Drug Pricing
| Measure | Rating |
| D09: MPF Price Accuracy | 4 |
| D10: Medication Adherence for Diabetes Medications | 5 |
| D11: Medication Adherence for Hypertension (RAS antagonists) | 5 |
| D12: Medication for Adherence for Cholesterol (Statins) | 4 |
| D13: MTM Program Completion Rate for CMR | 4 |
| D14: Statin Use in Persons with Diabetes (SUPD) | 4 |
**See our Star Rating Information for Network Health Medicare Advantage Plans and NetworkPrime (MSA). (Medicare evaluates plans based on a Five-Star rating system. Star Ratings are calculated each year and may change from one year to the next).
Quality Program Information
At Network Health, we have our own department that focuses on improving the quality of health care services you receive. Each year, our quality improvement department updates its quality improvement program structure, which includes the following.
- A written description of the quality improvement program
- Specifically addressing behavioral health care
- Specifically addressing patient safety
- The structure of the quality improvement program, accountable to the Board of Directors
- A designated physician who has substantial involvement in the quality improvement program
- A designated behavioral health care professional who is involved in behavioral health care aspects of the program
- A quality improvement committee that oversees the function of the organization
- The specific role, structure and function of the quality improvement committee and other connected committees, including how often they meet
- An annual quality work plan, including progress toward accomplishing goals
- A description of resources the organization devotes to the quality improvement program
For more information about Network Health's Quality Improvement Program, email us at QI@networkhealth.com.
