Quality

Health Plan Quality Program Summary

At Martin’s Point Health Care (Martin’s Point) we are committed to providing care and service that meets the highest standards for safety, effectiveness, and customer experience. We continually collect and analyze data in our effort to monitor our performance and identify areas for improvement.

Clinical guidelines offer an evidence-based framework to assist providers and patients in the diagnosis and treatment of common diseases and conditions. Martin’s Point selects clinical guidelines issued by nationally recognized expert bodies.  Click to download Martin's Point Health Care Clinical Guidelines

Standard measures of clinical quality and customer experience allow individuals to compare health plans and make informed choices when it comes to choosing a health plan provider for themselves and their family members. Two key measure sets are the Healthcare Effectiveness Data and Information Set (HEDIS®)1 and Consumer Assessment of Healthcare Providers and Systems (CAHPS®)2.

Martin’s Point, along with nearly every health plan in the US, uses HEDIS to measure quality of care. Martin’s Point strives to be among the best health plans in the nation by helping our members receive high quality care. In collaboration with our network providers, we support effective and affordable screening and treatment practices to prevent health issues and manage chronic conditions. While we work to ensure optimal health of individual members, we are also increasingly turning our attention toward population health concerns as we focus on the well-being of our community. We analyze data and reach out to both members and health care providers in our efforts to reduce health care “gaps” such as missed screening interventions. We are always innovating and looking for new ways to improve our performance as well as the health of our member populations.

We use the CAHPS surveys to ask members about their experiences with their health care, i.e. health plans, prescription plans, and care providers. The surveys focus on factors that members say are important to them, such as getting care easily and quickly, the quality of care provided by their primary care doctor or specialist, the coordination of their health care across the health care system, and overall service quality. When surveyed, our Martin’s Point health plan members continually exceed top benchmarks for member satisfaction. Our teams continually analyze CAHPS data and other performance indicators in our mission to provide the best service to our members.

Highlights of Martin’s Point HEDIS and CAHPS performance can be viewed at:

http://healthinsuranceratings.ncqa.org/2018/Default.aspx

The National Committee for Quality Assurance (NCQA), the leading authority on health plan quality, issues annual ratings for commercial health plans based on HEDIS performance and CAHPS scores. Our US Family Health Plans are rated at 4.5 out of 5 Stars.

Martin’s Point was first accredited by NCQA in 2013. We elected to participate in a rigorous comprehensive review of our performance by NCQA and our health plans have received NCQA’s seal of approval at Excellent and Commendable levels.

Each year the federal agency that administers Medicare, the Centers for Medicare & Medicaid Services, rates all Medicare Advantage plans on quality and performance.

You can use these Star Ratings to compare our plans' performance to other plans' performance using the Medicare Plan Finder tool, at:

https://www.medicare.gov/find-a-plan/questions/home.aspx

In 2018 our Generations Advantage Prime plan earned Medicare's highest rating, 5 stars.


1HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)

2CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ)