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.
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®).
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 MY2026 (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.
Quality Measure Description Table - Detailed clinical and member experience measure details
HEDIS 101 Best Practices for Improving Your Star Rating - Measure tips and best practice recommendations to improve measure performance
HEDIS 101 Associated Codes for Each Measure
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.
Digital Health Literacy Brochure
Health Equity Provider Checklist
Read Clinical Practice Guidelines
Statin Provider Reference Guide
Network Health uses the services of ComplexCare Solutions to help address opportunities in the health of our Medicare Advantage and Affordable Care Act (ACA) members. Initiatives, like the ComplexCare Solutions 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.
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.
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.
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).
The Medicare Diabetes Prevention Program is part of the National Diabetes Prevention Program, led by the Centers for Disease Control and Prevention (CDC) and is backed by years of research showing that program participants aged 60 and older can cut their risk of type 2 diabetes by 71 percent—by losing weight, eating better and being more active.
We are encouraging health care providers to consider referring patients to the lifestyle change program if they are at high risk for type 2 diabetes.
Learn more about the Medicare Diabetes Prevention Program
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
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.