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

 

 

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

Consult Newsletter Archives

To search newsletter archives by keyword, 
please use the "help me find..." search bar 
located at the top of the page. 

June 2019

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

 

 

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).

Commercial Preventive Services Guide 
Medicare Preventive Health Checklist

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:

 

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

Network Health
1570 Midway Place
Menasha, WI 54952
Hours
Mon., Wed.-Fri.: 8 a.m. to 5 p.m.
Tuesday: 8 a.m. to 4 p.m.