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Quality You Can Trust
Quality Program Information
Quality is engrained within the culture of Network Health and the work of each employee, but at Network Health, we do have a specific department that focuses on improving the quality of health care services you receive. Each year, our quality health integration 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 [email protected].
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 October 15, 2023.
Network Health's NCQA Ratings for 2023 are listed in the tables below.
(5 is the highest performance)
| Measure | Rating |
|---|---|
| Getting Care | 5 |
| Getting Care Easily | 5 |
| Getting Care Quickly | 5 |
| Satisfaction with Plan Physicians | 4.5 |
| Rating of Primary Care Doctor | 4 |
| Rating of Specialists | 4 |
| Coordination of Care | 5 |
| Satisfaction with Plan and Plan Services | 4.5 |
| Rating of Health Plan | 4 |
| Rating of Care | 5 |
| Measure | Rating |
|---|---|
| Cancer Screening | 4 |
| Breast Cancer Screening | 4 |
| Colorectal Cancer Screening | 4 |
| Other Preventive Services | |
| Flu Shots for Adults Age 65 and Older | 4 |
| Pneumonia Shots for Adults Ages 65 and Older | 4 |
| Equity | |
| Race and Ethnicity of Members | 5 |
| Measure | Rating |
|---|---|
| Respiratory | 4 |
| Appropriate testing and care for a sore throat | 4 |
| Appropriate antibiotic use for colds | 5 |
| Appropriate antibiotic use for acute bronchitis/bronchiolitis | 3 |
| Steroid After Hospitalization for Acute COPD | 5 |
| Bronchodilator After Hospitalization for Acute COPD | 4 |
| Diabetes | 4.5 |
| Patients with Diabetes - Blood Pressure Control (140/90) | 4 |
| Patients with Diabetes - Eye Exams | 4 |
| Patients with Diabetes - Glucose Control | 5 |
| Patients with Diabetes - Received Statin Therapy | 3 |
| 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 | 3 |
| Patients with Cardiovascular Disease - Statin Adherence 80% | 4 |
| Controlling High Blood Pressure | 5 |
| Behavioral Health - Care Coordination | 3.5 |
| Follow-up After Hospitalization for Mental Illness | 4 |
| Follow-up After ED for Mental Illness | 3 |
| Follow-up After ED for Substance Use Disorder | 3 |
| Follow-up After High-Intensity Care for Substance Use Disorder | 4 |
| 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 | 3 |
| Avoiding High-Risk Medications for Older Adults | 4 |
| Managing Risk of Falls | 1 |
| Managing Osteoporosis in Women After Fracture | 4 |
| 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 | 5 |
| Emergency Department Utilization | 3 |
| Acute Hospital Utilization | 5 |
| Hospitalization for Potentially Preventable Complications | 5 |
| Hospitalization Following SNF Discharge | 3 |
| Overuse of Opioids | 3 |
| Avoiding Opioids at High Dosage | 3 |
| Avoiding Opioids from Multiple Prescribers and Multiple Pharmacies | 2 |
| Avoiding Potentially Risky Continued Opioid Use | 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 throughout the nation. Our members appreciate our service and coverage—that’s why 93 percent stayed with us last year.* For 2024, Network Health earned a 5 out of 5 Star rating for our Medicare Advantage PPO plans—Medicare’s highest possible rating**.
Network Health Medicare PPO Star Ratings for 2024 are listed in the tables below.
(5 is the highest performance)
| Measure | Rating |
|---|---|
| Breast Cancer Screening | 5 |
| Colorectal Cancer Screening | 5 |
| Annual Flu Vaccine | 5 |
| 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 | 3 |
| Diabetes Care - Eye Exam | 5 |
| Diabetes Care - Blood Sugar Controlled | 5 |
| Controlling High Blood Pressure | 5 |
| Reducing the Risk of Falling | 2 |
| Improving Bladder Control | 4 |
| Medication Reconciliation Post-Discharge | 5 |
| Plan All-Cause Readmissions | 4 |
| 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 | 4 |
| Rating of Health Plan | 4 |
| Care Coordination | 5 |
| Measure | Rating |
|---|---|
| Complaints about the Health Plan | 5 |
| Members Opting to Leave the Plan | 5 |
| Health Plan Quality Improvement | 3 |
| Measure | Rating |
|---|---|
| Plan Makes Timely Decisions About Appeals | 5 |
| Reviewing Appeals Decisions | 2 |
| 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 | 2 |
| Measure | Rating |
|---|---|
| Rating of Drug Plan | 4 |
| Getting Needed Prescription Drugs | 5 |
| Measure | Rating |
|---|---|
| MPF Price Accuracy | 5 |
| 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 2023, for coverage starting January 2023.
