Quality Improvement Program

Purpose

We want to provide you with the best health care available. The CareSource Quality Improvement Program looks at both the medical and non-medical services you receive.

The purpose of the CareSource Quality Improvement Program is to ensure that CareSource has the necessary resources to:

  • Coordinate your care so that you receive the right care when you need it
  • Make sure you receive excellent, high quality, safe health care
  • Ensure your health care is provided by high performing doctors, hospitals and other health care experts
  • Always seek to improve the quality and safety of health care services provided to you
  • Help you understand how your neighborhood, your income and the other things in your life can affect your health
  • How you can make changes to improve your health

Our Quality Improvement Program is based on our CareSource mission and vision to improve your health and well-being. We follow the Institute for Healthcare Improvement’s “Triple Aim” goals to improve your health by making sure:

  • You have a good experience with your doctors, nurses and other health care experts
  • Achieve your best health
  • Your health care is provided in a cost-effective manner

Goals and Objectives

We set performance goals to guide us in providing you with the best health care possible. The CareSource Quality Improvement Program looks at both the medical and non-medical services you receive.

The goals of our Quality Program are:

  • Make sure we have the right programs in place that help you take care or your health conditions
  • Work with your doctor to make sure you are getting the best health care available
  • Do surveys to find out how satisfied you are with the care and services we provide
  • Ensure we follow-up on any complaints you have about your care
  • If you speak a language other than English, 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

We update our Program as needed based on:

  • Putting programs in place that help you take care of your health conditions
  • Information we receive from surveys of your health care team
  • Nationally accepted standards for medical care in the United States
  • Comments we receive from you on how to improve our services

Quality Measures

CareSource strives to be a top performing health plan nationally. Our CareSource Quality Improvement Program is overseen by doctors, nurses and other people trained in quality improvement. The CareSource Quality Improvement Program oversees how well your health care team takes care of you and makes sure CareSource meets all The Centers for Medicare and Medicaid Services (CMS) guidelines for quality health care. CareSource regularly reviews member quality of care, how healthy you are and how satisfied you are with the services we provide.

The HEDIS® (Healthcare Effectiveness Data and Information Set) is one way we measure the quality of the health care CareSource provides. We collect information on how well we are doing with providing members with certain services and types of health care. For example, we track how many people with diabetes get their annual eye exam or how many people with asthma are prescribed a rescue inhaler.

The Medicare CAHPS® (Consumer Assessment of Healthcare Providers and Systems) is an annual questionnaire that asks a randomly selected number of Medicare members about their experience with doctors, hospitals and other health care professionals. Some examples of the questions include:

  • How your doctor or other health care team members talk with you, for example, answer your questions, do they spend enough time with you?
  • Knowledge of the medicines you take and why you take them
  • Making sure you get appointments with other health care experts, if needed, for example physical therapy or a doctor that specializes in arthritis or diabetes

Each year Medicare evaluates health plans, like CareSource, based on a 5-star rating system. CMS uses the five-star quality rating system to measure your experience with both CareSource and your health care team. Star Ratings are based on how well CareSource does in the categories below:

  • Keeping you healthy, which 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 Information

CareSource provides our members with information and guidelines on how to take care of long-term and common health conditions, as well as education on ways to stay healthy. 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 the CareSource Quality Improvement Program, please call Member Services at 1-855-475-3163 (TTY: 1-800-750-0750 or 711), 8 a.m. to 8 p.m., Monday – Friday.