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Provider Resources

We Integrate Quality Every Day

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 our members and ensuring that they get the right care, at the right place and the right time. 

One of the ways we do that is by coordinated efforts with providers to improve the effectiveness of member care across conditions, providers, settings and time. The expected outcome is high-quality care that is safe, efficient, timely, unbiased and patient-focused. 

Learn more about our Clinical Integration program.

How We Rate

Network Health evaluates the quality of care and services provided to members using two nationally-recognized tools, the Healthcare Effectiveness and Data Information Set (HEDIS®) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®).

Learn more about our ratings

HEDIS (Healthcare Effectiveness Data and Information Set)

Network Health partners with providers to offer quality healthcare to our members, as measured through HEDIS quality measures. The National Committee of Quality Assurance (NCQA) defines HEDIS as “a set of standardized performance measures designed to ensure that the public has the information it needs to compare organization performance.” HEDIS MY2020 (MY=Measurement Year) examines care provided for a number of conditions across all body systems; addresses members’ access to, and satisfaction with, various health care services; and measures utilization for specific procedures and care settings.

View our HEDIS 101 Reference Guide to learn more about HEDIS and how the scores are used.

Clinical Guidelines

Network Health adopts and follows clinical practice guidelines to improve the quality of care for our members by assisting physicians and practitioners with a framework for specific illnesses. 

Read Clinical Practice Guidelines

Inovalon Overview

Network Health uses the services of Inovalon to help address opportunities in the health of our Medicare Advantage and Affordable Care Act (ACA) members. Initiatives, like the Inovalon partnership, complement the efforts of providers to improve the overall health of our members by evaluating current health conditions and applying additional strategies to close gaps in care.

Find out more here

The Consult Newsletter

Every month, The Consult tells you about our member programs designed to close care gaps and initiatives around specific quality measures, and shares highlights from our health management teams and network providers.

Check out the latest issue of The Consult

 
Newsletter archives are also available - view a list of past issues here. Or, to search newsletter archives by keyword, 
use the "help me find..." search bar located at the top of the page. 

Preventive Services Guide

In addition to an annual wellness visit, Network Health covers other preventive services at no cost for most of our members when they visit doctors within our provider network. Network Health follows the recommendations of the United States Preventive Services Task Force (USPSTF).

Member Wellness Programs 

Network Health offers a variety of member programs and incentives to educate patients on healthy lifestyle choices, wise use of medical services and what to expect in the billing process. We also work with health care system colleagues to provide awareness and intervention programs.

Learn more about our wellness programs for members

 
 
 
  

 
 

Working Together to Close Care Gaps

Network Health collaborates with providers to ensure that member care meets the highest quality standards. We seek ways to share information about the services provided, identify and address missing services and avoid duplicate services.

In addition to our work with providers, our quality efforts include member outreach programs designed to close care gaps. Those member materials are shared with providers here and in The Consult monthly newsletter.

How to Meet the 2019 HEDIS® Measure for Kidney Evaluation in Patients with Diabetes
Related Member materials:


Network Health
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Menasha, WI 54952
Hours
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Tuesday: 8 a.m. to 4 p.m.