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 January 15, 2023.

Network Health's NCQA Ratings for 2022-23 are listed in the tables below.

(5 is the highest performance)

Patient Experience (Score 4.5)

Measure	Rating
Getting Care	5
Getting Care Easily	5
Getting Care Quickly	5
Satisfaction with Plan Physicians	4
Rating of Primary Care Doctor	4
Rating of Specialists	4
Coordination of Care	4
Satisfaction with Plan and Plan Services	4
Rating of Health Plan	4
Rating of Care	4

Prevention (Score - 4)

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

Treatment (Score - 4)

Measure	Rating
Respiratory	4
Steroid After Hospitalization for Acute COPD	4
Bronchodilator After Hospitalization for Acute COPD	4
Diabetes	4
Blood Pressure Control (140/90)	4
Eye Exams	3
Glucose Control	5
Patients with Diabetes - Received Statin Therapy	3
Patients with Diabetes - Statin Adherence 80%	4
Heart Disease	4
Patients with Cardiovascular Disease - Received Statin Therapy	3
Patients with Cardiovascular Disease - Statin Adherence 80%	4
Controlling High Blood Pressure	4
Behavioral Health - Care Coordination	3.5
Follow-up After Hospitalization for Mental Illness	5
Follow-up After ED for Mental Illness	2
Follow-up After ED for Alcohol and Other Drug Abuse or Dependence	3
Follow-up AFter High-Intensity Care for Substance Use Disorder	4
Behavioral Health - Medication Adherence	4.5
Adherence to Antipsychotic Medications for Individuals with Schizophrenia	5
Patients with Opioid Use Disorder - Medication Adherence for Six Months	N/A
Patients with New Episode of Depression - Medication Adherence for Six Months	4
Behavioral Health - Access, Monitoring and Safety
Alcohol or Drug Abuse or Dependence Treatment Engaged	3
Patient Safety and Treatment for Older Adults	3
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	3
Managing Osteoporosis in Women After Fracture	3
Care Coordination	5
Follow-up After ED for Multiple High-Risk Chronic Conditions	4
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 96 percent stayed with us last year.* For 2023, 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 2023 are listed in the tables below.

(5 is the highest performance)

Staying Healthy

Measure	Rating
Breast Cancer Screening	5
Colorectal Cancer Screening	5
Annual Flu Vaccine	4
Monitoring Physical Activity	3

Managing Chronic (Long Term) Conditions

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	2
Diabetes Care - Eye Exam	4
Diabetes Care - Kidney Disease Monitoring	4
Diabetes Care - Blood Sugar Controlled	5
Rheumatoid Arthritis Management	5
Reducing the Risk of Falling	2
Improving Bladder Control	4
Medication Reconciliation Post-Discharge	5
Statin Therapy for Patients with Cardiovascular Disease	4

Member Experience with Health Plan

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

Member Complaints and Changes in the Health Plans Performance

Measure	Rating
Complaints about the Health Plan	5
Members Opting to Leave the Plan	5
Health Plan Quality Improvement	4

Health Plan Customer Service

Measure	Rating
Plan Makes Timely Decisions About Appeals	5
Reviewing Appeals Decisions	4
Call Center - Foreign Language Interpreter and TTY Availability	5

Drug Plan Customer Service

Measure	Rating
Call Center - Foreign Language Interpreter and TTY Availability	5

Member Complaints and Changes in the Drug Plan's Performance

Measure	Rating
Complaints about the Drug Plan	5
Members Choosing to Leave the Plan	5
Drug Plan Quality Improvement	3

Member Experience with the Drug Plan

Measure	Rating
Rating of Drug Plan	4
Getting Needed Prescription Drugs	5

Drug Safety and Accuracy of Drug Pricing

Measure	Rating
MPF Price Accuracy	5
Medication Adherence for Diabetes Medications	4
Medication Adherence for Hypertension (RAS antagonists)	5
Medication for Adherence for Cholesterol (Statins)	4
MTM Program Completion Rate for CMR	5
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 2022, for coverage starting January 2022.

**See our 2023 Star Rating Information for Network Health PPO Medicare Advantage Plans, Network Health Medicare Explore (HMO) and Network 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).

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