About Network Health

How We Rate

The National Committee for Quality Assurance (NCQA) Rates Medicare plans 

NCQA rates Medicare insurance plans based on their combined Healthcare Effectiveness and Data Information Set (HEDIS®) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) and NCQA Accreditation standards scores. Accreditation status is as of June 30, 2019.

Network Health's NCQA Ratings for 2019-2020 are listed in the tables below.

Key
5 - Higher Performance 


2
1 - Lower Performance
NA - Not Applicable

Consumer Satisfaction (Score - 4)

Plan Details Score
Getting Care 4
Getting Care Quickly 4
Getting Needed Care 4
Satisfaction with Plan Physicians 4.5
Rating of Personal Doctor 5
Rating of Specialist Seen Most Often 4
Rating of All Health Care 4
Satisfaction with Plan Services 3
Rating of Health Plan 3

Prevention (Score - 4)

Plan Details Score
Breast Cancer Screening 4
Colorectal Cancer Screening 4
Pneumonia Vaccinations 4
Flu Vaccinations 3

Treatment (Score - 4)

Plan Details Score
Diabetes 4
Diabetes Care - Eye Exam 3
Diabetes Care - Blood Pressure Control (<140/90 mm Hg) 4
Diabetes Care - HbA1c Control (<8.0%) 5
Patients with Diabetes - Received Statin Therapy 3
Patients with Diabetes - Statin Adherence 80% 4
Heart Disease 3.5
Patients with Cardiovascular Disease - Recieved Statin Therapy 3
Patients with Cardiovascular Disease - Statin Adherance 80% 4
Controlling High Blood Pressure 4
Smoking Advice 2
Mental and Behavioral Health 3.5
Depression: Adhering to medication for 6 months 4
Follow-Up After Hospitalization for Mental Illness 2
Follow-Up After Emergency Department for Mental Illness 3
Follow-Up After Emergency Department for Alcohol and Other Drug Abuse or Dependence 4
Initiation and Engagement of Alcohol and Other Drug Dependence Treatment 4
Other Treatment Measures 4.5
Observed-to-Expected Hospital Readmissions 5
Management for COPD Exacerbation - Bronchodilators 3
Management for COPD Exacerbation - Systemic Corticosteroids 5
Managing the Risk of Falls 2
Managing Osteoporosis in Women After a Fracture 2
Use of High-Risk Medications in Elderly 4
Non-Recommended PSA-Based Screening in Older Men (PSA) 3
Potentially Harmful Drug-Disease Interactions in Elderly 4
Emergency Department Utilization 3
Hospitalization for Potentially Preventable Complications 3
Acute Hospital Utilization 1
Follow-Up After Emergency Department for Multiple High-Risk Chronic Conditions 4
Medication Reconciliation Post-Discharge 5
Potentially Inappropriate Use of Opioids at High Dosage 4
Potentially Inappropriate Use of Opioids from Multiple Prescribers and Pharmacies 4
Transition of Care - Notification of Inpatient Admission 5
Transition of Care - Receipt of Discharge Information 5
Transition of Care - Patient Engagement After Inpatient Discharge 4
Transition of Care - Medication Reconciliation Post-Discharge 5

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 4.5 out of 5 stars.**

Network Health Medicare PPO Star Ratings for 2020 are listed in the tables below.

Key
5 - Higher Performance 


2
1 - Lower Performance
NA - Not Applicable

HD1: Staying Healthy

 Measure  Rating
 C01: Breast Cancer Screening  4
 C02: Colorectal Cancer Screening  4
 C03: Annual Flu Vaccine  4
 C04: Improving or Maintaining Physical Health  4
 C05: Improving or Maintaining Mental Health  4
 C06: Monitoring Physical Activity  3
 C07: Adult BMI Assessment  5

 

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  5
 C12: Osteoporosis Management in Women who had a Fracture  1
 C13: Diabetes Care - Eye Exam  5
 C14: Diabetes Care - Kidney Disease Monitoring  5
 C15: Diabetes Care - Blood Sugar Controlled  5
 C17: Rheumatoid Arthritis Management  5
 C18: Reducing the Risk of Falling  2
 C19: Improving Bladder Control  4
 C20: Medication Reconciliation Post-Discharge  5
 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  3
 C26: Rating of Health Care Quality  5
 C27: Rating of Health Plan  3
 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  5
 C31: Health Plan Quality Improvement  4 
 C32: Plan Makes Timely Decisions About Appeals  4

 

HD5: Health Plan Customer Service

 Measure  Rating
 C33: Reviewing Appeals Decisions  3
 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  4
 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  5
 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  5 

 

DD4: Drug Safety and Accuracy of Drug Pricing

 Measure   Rating
 D09: MPF Price Accuracy  5
 D10: Medication Adherence for Diabetes Medications  5
 D11: Medication Adherence for Hypertension (RAS antagonists)  5
 D12: Medication for Adherence for Cholesterol (Statins)  5
 D13: MTM Program Completion Rate for CMR  5
 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.


Network Health
1570 Midway Place
Menasha, WI 54952
Hours
Mon., Wed.-Fri.: 8 a.m. to 5 p.m.
Tuesday: 8 a.m. to 4 p.m.