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How Network Health Is Different From Other Health Plans

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.

Network Health hats at the Timber Rattlers

We Live In Your Community

Being local allows us to focus on our mission of creating healthy and strong Wisconsin communities. We care about making our home a better place to live.
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We Are Provider-Owned

Network Health is locally owned by Froedtert ThedaCare Health. We collaborate with our provider-owners to give members access to high-quality coordinated care.
a couple of Medicare age

We Speak Your Language

When you call us, we don’t bombard you with health insurance jargon. We talk like people, not insurance dictionaries.
Network Health 5-star rating

5-Star Rating

For 2025, Network Health earned a 5 out of 5 Star rating for our Medicare Advantage PPO plans—Medicare’s highest possible rating.**
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We Embrace Diversity

To accomplish our mission, we value and celebrate diversity across Wisconsin. We do our best by embracing diversity, inclusion and social justice as part of our value.
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We Focus On Healthy Living

We believe in helping people lead healthy lives, not just helping out when they get sick. As a member, you’ll have access to programs that help you improve or maintain your health.
new to Network Health member meeting

We Assess Your Needs

Network Health provides guidance to all our members with complex conditions to ensure they receive the necessary services. Each year, we assess the demographics of our members to ensure we meet their needs.
Network Health at Capri Communities

Quality That Matters

A 5-Star rating means you have a plan that shines at serving its members and keeping them healthy. The Centers for Medicare & Medicaid Services also rewards high-rated plans with bonus payments to be spent on extra member benefits.

Quality You Can Trust

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


Network Health’s Rating With the National Committee for Quality Assurance (NCQA)

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

Stars Rating 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 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
* Based on the percentage of Network Health Medicare Advantage (PPO) members who stayed on the plan for 2024, for coverage starting January 2024.
** See our 2025 Star Rating Information for Network Health PPO Medicare Advantage Plans, Network Health Medicare Explore (HMO) and Network Health Prime (MSA) plans. (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).