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We look forward to serving you. We want your experience with us to be great. We promise to serve and care for you in the same way we would want our family to be treated.
Ultimate Health Plans maintains a Quality Program to improve quality of care and member health outcomes. The Quality Program provides the framework for how we monitor the quality of care and services that our members receive. Through this program, we develop clinical initiatives and process improvements. Ultimate Health Plans measures the program's effectiveness on an annual basis.
Ultimate Health Plans analyzes many different types of data, including member clinical data (such as claims, lab results, and diagnoses) as well as member and provider appeals and grievances. Ultimate Health Plans also monitors its internal processes.
Ultimate Health Plans annually measures the quality of care and services its members receive through the use of the Healthcare Effectiveness Data and Information Set (HEDIS®). Ultimate Health Plans also conducts annual member surveys to determine what members think about the health plan, their physicians, and their own health. This survey is called the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. We also look at member responses to the Medicare Health Outcomes Survey (HOS), which tells us how its members feel about their health.
Ultimate Health Plans also monitors measures of patient safety on an annual basis. Ultimate Health Plans maintain programs to improve patient safety, such as through medication reconciliation and the use of high-risk medications.
Ultimate Health Plans uses the Quality Program to implement ongoing, continuous quality improvement projects and interventions. Examples of quality projects may include:
One of the ways that you can determine how well we are doing is by looking at our Medicare Star Rating. Every year, Medicare evaluates plans based on a 5-star rating system. This system is based on the health plan’s quality and performance. You can find information about our current star rating below.
Ultimate Health Plans is evaluated by the National Committee for Quality. You can review our report card by clicking here.
Ultimate Health Plans also establishes internal goals and benchmarks in an annual quality work plan. Quality monitoring information is reported to the Quality Management Steering Committee. This committee reports to the Ultimate Health Plans Board of Directors.
For more information about this program, please contact Member Services at 1-888-657-4170 (TTY 711).