Quality Improvement


We want to provide you with the best health care available. The purpose of the CareSource Quality Improvement Program is to ensure that CareSource has the necessary tools to:

  • Coordinate your care so that you receive the right care when you need it.
  • Make sure you receive excellent, high quality health care.
  • Ensure your health care is provided by efficient, high-performing doctors and hospitals.
  • Always seek to improve the quality and safety of health care services provided to you.
  • Ensure the care you receive is safe.

Our Quality Improvement Program is based on our CareSource mission and vision to improve your health and well-being:

  • Our mission is to make a lasting difference in our members’ lives by improving their health and well-being.
  • Our vision is to transform lives through innovative health and life services.
  • We follow The Institute for Healthcare Improvement’s Triple Aim goals to
    • Have a good experience with your health care team.
    • You achieve your best health.
    • Your health care is provided in a cost-effective manner.

The CareSource Quality Improvement Program includes the medical and non-medical services you receive. We update our Program as needed based on:

  • Your needs
  • Comments from your medical team
  • National standards for medical care
  • CareSource business needs

Goals and Objectives

CareSource Dual Advantage strives to be a top performing health plan nationally. We set performance goals based on national standards for providing health care.

The goals of our Quality Program are:

  • Make sure we achieve a high level of performance on the Healthcare Effectiveness Data and Information Set, also called HEDIS®.
    • HEDIS® measures how well CareSource provides service and care to you
  • Make sure we are fully meeting your needs by reviewing the Medicare Consumer Assessment of Health Care Providers and Systems, or MCAHPS® annual survey.
      • CAHPS® is a questionnaire from Medicare that asks a certain number of people every year about their experience with their health care team, such as:
        • How your provider talks with you.
        • Understanding how you take your medicines.
        • Ensuring you get to other appointments, like physical therapy or a specialty doctor.
  • Make sure we have programs in place that help you take care of your health conditions.
  • Work with your doctor to make sure you are getting the best health care.
  • Ensure the care you receive is high quality and safe.
  • Do surveys to find out how satisfied you are with our care and services.
  • Ensure we follow-up on any complaints you have about the health care you receive.
  • If you speak a language other than English, we want to make sure you understand the information you receive from CareSource and your health care team by providing interpreter services and information in your language.
  • Ensure you have providers, hospitals and other health care services available close to where you live.

Quality Measures

The CareSource Quality Improvement Program oversees quality improvement activities. This is to make sure we are meeting all CareSource Dual Advantage guidelines for quality.

The Quality Improvement Program is overseen by doctors, nurses and other people trained in quality.

CareSource regularly reviews member quality of care, how healthy you are and how satisfied you are with the services we provide. We have measures in place to determine how well we are doing.

Every year, Medicare evaluates plans based on a 5-star rating system. The Centers for Medicaid and Medicare use a five-star quality rating system to measure Medicare Advantage beneficiaries’ experience with both CareSource and your health care team. Star Ratings are based on how well CareSource is doing across the categories below:

  • Staying healthy. This includes getting:
    • Regular check-ups.
    • Vaccines, such as flu and shingles shots.
    • Screening checks, such as for breast cancer.
  • How well you are able to take care of long-term health conditions you may have.
  • Your experience and satisfaction with CareSource and our health care services.
  • How well we handle your complaints.
  • What you think of Member Services.

Member Health Guidelines

CareSource provides Dual Advantage members with resources for a number of health conditions and also guidelines to keep you healthy. The guidelines are approved by our Medical Directors and other providers CareSource works with.

Information about our CareSource member health guidelines and other health information can be found on the member website.

If you would like more information on CareSource Quality Improvement, please call Member Services at 1-833-230-2020 (TTY: 711). We are open 8 a.m. to 8 p.m. Monday through Friday, and from October 1 through March 31 we are open the same hours, seven days a week.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ)