Quality healthcare is our passion; improving lives is our reward!
The Prominence Health Plan Quality Improvement (QI) Program is designed to assess and improve the quality of care and service delivered to its members. The goal is to monitor and improve the quality and appropriateness of patient care and services. To achieve this goal, Prominence Health Plan will make every effort to meet national standards for the delivery of care and services, measure performance outcomes, and develop and implement action plans to improve outcomes.
Here’s what Prominence Health Plan does each year:
- Collects and evaluates data on the Healthcare Effectiveness Data and made Information Set (HEDIS®) clinical measures. HEDIS are a set of standardized clinical measures designed to assist employers and consumers in comparing health plan performance in areas like breast cancer screening, comprehensive diabetes care, childhood immunizations, controlling high blood pressure, smoking cessation and more. Prominence Health Plan’s goal is to be better than 75% of other health plans.
- Asks members how satisfied they are with Prominence Health Plan as a health plan. This is done through the Consumer Assessment of Healthcare Providers and Systems (CAHPS®), which is a standardized survey of consumers’ experiences conducted annually to evaluate Prominence Health Plan’s performance in areas such as access to needed care, getting care quickly, physician communications, customer service and claims processing. Prominence Health Plan’s goal is to be better than 75% of other health plans.
- Collects and evaluates data for the STARS program. STARS is a ranking scale of one to five administered by the Centers for Medicare and Medicaid Services for Medicare line of business. It is a combination of HEDIS, CAHPS and other administrative measures.
- Shares progress on meeting these goals with members and providers. Visit Progress on Meeting Goals to learn how Prominence Health Plan is improving on HEDIS, CAHPS and STARS.
- Asks providers how satisfied they are with Prominence Health Plan as a health plan.
- Reviews performance to determine whether goals were met and makes plans for continued improvement.
- Works to maintain its accreditation by the National Committee for Quality Assurance (NCQA) through continuous oversight and evaluation of processes. NCQA accreditation involves a rigorous review of Prominence Health Plan’s consumer protection and quality improvement systems and requires annual submission of HEDIS and CAHPS audited data. Visit NCQA Accreditation to learn more about this program.
- Provides members with Important Member Information to keep members informed about key aspects of the health plan.
To learn more about Prominence Health Plan’s Quality Improvement Program, its progress on meeting goals or to request a copy of the QI Program, please contact Customer Service.