Quality Improvement

Purpose

We want to provide you with the best health care available. The purpose of the CareSource Medicare Advantage 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 high quality-excellent-health care
  • Ensure your health care is provided by high-performing, efficient doctors and hospitals
  • Always seek to improve the quality and safety of health care services provided to you
  • Help you understand how your neighborhood, your income and other things in your life can affect your health, and how you can make changes to improve your health

Our Quality Improvement Program is based on these guiding principles:

  • Our mission, which we call our heartbeat, 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 standards to:
    • Improve your health while at the same time ensuring you:
      • 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 Medicare Advantage 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 Medicare 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
    • It is one way to measure the quality of care and services we provide
  • Ensure we achieve a high level of performance on the Medicare Consumer Assessment of Healthcare Providers and Systems, also called Medicare CAHPS®
    • CAHPS® is a questionnaire from Medicare that asks you about your experience with your health care team, such as:
      • How your doctor 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 along 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 your care
  • 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
  • Ensure you have doctors, hospitals and other health care services available close to you

Quality Measures

The CareSource Medicare Advantage Quality Improvement Program oversees quality improvement activities. This is to make sure we are meeting all CareSource Medicare Advantage guidelines for quality. This information can be found in Chapter 5 of the Centers for Medicare and Medicaid Services Medicare Managed Care Manual.

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 our Customer Service Department

Member Health Guidelines

CareSource provides Medicare Advantage members with resources and guidelines for a number of health conditions and also preventive health guidelines. The guidelines are approved by our Medical Directors and other doctors 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: 1-800-750-0750 or 711). Our hours are 8 a.m. to 8 p.m. EST, seven days a week from October 1 to March 31, and Monday through Friday the rest of the year.

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)