Quality Assurance
Learn how we make sure your care and coverage meet the highest quality standards.
Primary Care Incentives and Hospital Quality Improvement
Our Primary Care Physician Incentive Plan and Hospital Quality Improvement Plan allow providers and hospitals to participate in an incentive program, rewarding them for meeting certain nationally recognized quality standards and patient safety goals. Doctors must choose to participate in this program, and you can check to see if your physician group participates by using our Find a Doctor tool.
Quality Improvement Initiatives
Per our Centers for Medicare and Medicaid Services (CMS) contract, every year we implement new Quality Initiatives that will help improve how members manage their care and health. One of the initiatives we are proud to promote is our Care Management Program—our solution for members managing complex health conditions. If you’re identified in this program, a registered nurse case manager will call you to:
- Assess your health needs
- Provide education about your symptoms, condition, and medication
- Help you follow your doctor’s treatment plan
- Collaborate with you to develop health care goals
- Help you develop self-management skills
- Collaborate and coordinate care with your doctors
- Inform you about community resources
- Assist you in understanding your health plan benefits
Chronic Condition Management
Our Chronic Condition Management program is a voluntary service offered at no cost to members managing one or more chronic health conditions. This program is designed to help members with the day-to-day management of coronary artery disease, diabetes, and other chronic conditions. If you're invited to participate, you have the right to decline, but we recommend you take full advantage of the assistance the program can provide.
This is not a complete description of benefits. Call 1-800-200-4255 (TTY: 711) for more information.
