If you’re looking for the largest, most widespread health plan in the country, that’s not us. If you’re looking for informed people you can reach in person or on the phone, who answer questions directly – that’s us. We take a different approach to health insurance, providing personalized service while treating you with courtesy and respect. From our headquarters in Menasha to our office in Brookfield, we work to meet the needs of our members throughout Wisconsin.
Quality is engrained within the culture of Network Health and the work of each employee. Our commitment to quality isn’t about our awards, excellent quality ratings or accreditations. Yes, we continue to exceed the industry’s highest standards, but at Network Health we put the spotlight on you.
Our quality department focuses on improving the health care services you receive every day, ensuring your experience with Network Health exceeds expectations. And our members appreciate our level of service and coverage. That’s why 98 percent stayed with us last year.*
For more information about Network Health’s Quality Improvement Program, email us at QI@networkhealth.com
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 September 15, 2024.
Network Health’s NCQA ratings for 2024 are below. Please click on the arrow to expand each section.
Measure | Rating |
---|---|
Getting Care | 4.5 |
Getting Care Easily | 5 |
Getting Care Quickly | 4 |
Satisfaction with Plan Physicians | 4 |
Rating of Primary Care Doctor | 4 |
Rating of Specialists | 3 |
Coordination of Care | 5 |
Satisfaction with Plan and Plan Services | 4 |
Rating of Health Plan | 4 |
Rating of Care | 4 |
Measure | Rating |
---|---|
Cancer Screening | 4.5 |
Breast Cancer Screening | 4 |
Colorectal Cancer Screening | 5 |
Other Preventive Services | |
Influenza immunizations for adults | 5 |
Td/Tdap immunizations for adults | 5 |
Zoster immunizations for adults | 5 |
Pneumococcal immunizations for adults | 5 |
Equity | |
Race and Ethnicity of Members | 5 |
Measure | Rating |
---|---|
Respiratory | 4.5 |
Appropriate testing and care for a sore throat | 4 |
Appropriate antibiotic use for colds | 5 |
Appropriate antibiotic use for acute bronchitis/bronchiolitis | 4 |
Steroid After Hospitalization for Acute COPD | 5 |
Bronchodilator After Hospitalization for Acute COPD | 4 |
Diabetes | 5 |
Patients with Diabetes - Blood Pressure Control (140/90) | 5 |
Patients with Diabetes - Eye Exams | 5 |
Patients with Diabetes - Glucose Control | 5 |
Patients with Diabetes - Received Statin Therapy | 4 |
Patients with Diabetes - Statin Adherence 80% | 4 |
Patients with Diabetes - Kidney Health Evaluation | 5 |
Heart Disease | 4.5 |
Patients with Cardiovascular Disease - Received Statin Therapy | 4 |
Patients with Cardiovascular Disease - Statin Adherence 80% | 4 |
Controlling High Blood Pressure | 5 |
Behavioral Health - Care Coordination | 4 |
Follow-up After Hospitalization for Mental Illness | 4 |
Follow-up After ED for Mental Illness | 3 |
Follow-up After ED for Substance Use Disorder | 5 |
Behavioral Health - Medication Adherence | 4 |
Adherence to Antipsychotic Medications for Individuals with Schizophrenia | 4 |
Patients with New Episode of Depression - Medication Adherence for Six Months | 4 |
Behavioral Health - Access, Monitoring and Safety | |
Substance Use Disorder Treatment Engagement | 3 |
Patient Safety and Treatment for Older Adults | 3.5 |
Avoiding Non-recommended Prostate Cancer Screening in Older Men | 3 |
Avoiding Potentially Harmful Drug and Disease Interactions in Older Adults | 4 |
Avoiding High-Risk Medications for Older Adults | 4 |
Managing Risk of Falls | 2 |
Managing Osteoporosis in Women After Fracture | 4 |
Screening for Osteoporosis in Women | 5 |
Care Coordination | 5 |
Follow-up After ED for Multiple High-Risk Chronic Conditions | 5 |
Transitions of Care - Notification of Inpatient Admission | 5 |
Transitions of Care - Receipt of Discharge Information | 5 |
Transitions of Care - Patient Engagement After Inpatient Discharge | 5 |
Transitions of Care - Medication Reconciliation Post-Discharge | 5 |
Risk-Adjusted Utilization | 4 |
Plan All-Cause Readmissions | 3 |
Emergency Department Utilization | 3 |
Acute Hospital Utilization | 5 |
Hospitalization for Potentially Preventable Complications | 5 |
Hospitalization Following SNF Discharge | 3 |
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 throughout the nation. For 2025, Network Health earned a 5 out of 5 Star rating for our Medicare Advantage PPO plans, Medicare’s highest possible rating, while also receiving the following ratings for key individual measures.**
→ Rating of Health Plan - 5
→ Getting Appointments and Care Quickly - 5
→ Customer Service - 5
→ Rating of Drug Plan - 4
Network Health Medicare PPO Star Ratings for 2025 are listed in full in the tables below. Please click on the arrow to expand each section.
(5 is the highest performance)
Measure | Rating |
---|---|
Breast Cancer Screening | 4 |
Colorectal Cancer Screening | 5 |
Annual Flu Vaccine | 4 |
Monitoring Physical Activity | 3 |
Measure | Rating |
---|---|
Special Needs Plan (SNP) Care Management | 4 |
Care for Older Adults - Medication Review | 5 |
Care for Older Adults - Pain Assessment | 5 |
Osteoporosis Management in Women who had a Fracture | 4 |
Diabetes Care - Eye Exam | 5 |
Diabetes Care - Blood Sugar Controlled | 5 |
Controlling High Blood Pressure | 5 |
Reducing the Risk of Falling | 1 |
Improving Bladder Control | 3 |
Medication Reconciliation Post-Discharge | 5 |
Plan All-Cause Readmissions | 3 |
Statin Therapy for Patients with Cardiovascular Disease | 4 |
Transitions of Care | 5 |
Follow-up after Emergency Department Visit for Patients with Multiple Chronic Conditions | 5 |
Measure | Rating |
---|---|
Getting Needed Care | 5 |
Getting Appointments and Care Quickly | 5 |
Customer Service | 5 |
Rating of Health Care Quality | 5 |
Rating of Health Plan | 5 |
Care Coordination | 5 |
Measure | Rating |
---|---|
Complaints about the Health Plan | 5 |
Members Opting to Leave the Plan | 5 |
Health Plan Quality Improvement | 4 |
Measure | Rating |
---|---|
Plan Makes Timely Decisions About Appeals | 5 |
Reviewing Appeals Decisions | 3 |
Call Center - Foreign Language Interpreter and TTY Availability | 4 |
Measure | Rating |
---|---|
Call Center - Foreign Language Interpreter and TTY Availability | 4 |
Measure | Rating |
---|---|
Complaints about the Drug Plan | 5 |
Members Choosing to Leave the Plan | 5 |
Drug Plan Quality Improvement | 5 |
Measure | Rating |
---|---|
Rating of Drug Plan | 4 |
Getting Needed Prescription Drugs | 5 |
Measure | Rating |
---|---|
MPF Price Accuracy | 4 |
Medication Adherence for Diabetes Medications | 5 |
Medication Adherence for Hypertension (RAS antagonists) | 5 |
Medication for Adherence for Cholesterol (Statins) | 4 |
MTM Program Completion Rate for CMR | 4 |
Statin Use in Persons with Diabetes (SUPD) | 3 |