Quality Improvement

Thank you for trusting us with your health care coverage. We’re dedicated to improving your health. There’s nothing we take more seriously than making sure the care you receive is safe, effective and timely. Every member of our staff is part of your quality improvement team, working toward patient-centered care that brings you peace of mind through better health.

How does our quality rank with other health plans?

We were awarded a 3.5 Star Quality rating for 2018-2019 from the National Committee for Quality Assurance (NCQA). We are among the highest rated Medicaid Health Plans in Tennessee.

In 2018, NCQA rated more than 1,000 health insurance plans based on clinical quality, member satisfaction and NCQA Accreditation Survey results. Find more information on the NCQA website.

Health Information

As part of our quality efforts, we’ve made health information easy for you to find on this website. Take a look at Your Health. Or go to Health Topics. Some topics that may interest you are:

  • ADHD
  • Antibiotics
  • Asthma
  • COPD
  • Depression
  • Diabetes
  • Heart Disease
  • Quitting Smoking

What does this mean for you as our member?

  • We are committed to quality.
  • We provide high-quality care and services.
  • We measure the care you receive.
  • We find out how your feel about your care.
  • We meet guidelines for protecting and improving your health.

How do we measure quality?

The tools we use to measure quality are developed by organizations such as NCQA, Centers for Medicare and Medicaid Services and the Agency for Healthcare Research and Quality. Many other health plans also use these tools. These organizations share our scores with the public. You can compare how different health plans improve their members’ health.

What does quality mean to us as your Health Plan?

Quality is more than a rating to us. How well we’re helping you with your health is at the heart of everything we do. We look for answers to questions like these:

  • Are you getting checkups and screenings you need?
  • Do you take the medicines that are prescribed?
  • If you’re pregnant, do you get prenatal care?
  • If you have a health condition – like heart disease or diabetes – do you get the extra help you need to stay on top of it?
  • Do you feel you have a good choice of health care providers?
  • How easy is it for you to get care?

To get these answers, data is collected from sources like claims and chart reviews. We also survey you and your providers to find out how we can better meet your needs.

Each year, our Quality Improvement Program reviews our data to:

  • Make sure you get high-quality care and services
  • Make sure you get the right care
  • Make sure it is easy for you to get care

But there’s more we want to do — particularly about preventing health problems or helping you live well despite an issue.

If caught early, many health problems can be treated before they affect your long-term health. Screenings and tests help make this possible. That’s why we remind you of checkups and screenings by phone, mail, text and email. That’s why we host health fairs, screenings and events throughout the state.

What are our Quality Goals and Objectives

  • Be the best TennCareSM Managed Care Organization
  • Maintain high commendable accreditation by NCQA
  • Achieve 4-Star rating across all regions in Tennessee
  • Provide superior member and provider satisfaction
  • Provide effective health care cost and utilization
  • Improve health care delivery and coordination
  • Improve the health of our members