2020 Quality Improvement Program overview

Last modified: May 6, 2021

2020 Quality Improvement Program overview

UnitedHealthcare maintains a Quality Improvement (QI) program to improve our members’ and providers’ health care experience. The following are the most important activities in our QI 2020 program for UnitedHealthcare commercial plans.

Monitoring and improving clinical performance and service measures

We monitored all aspects of quality, including but not limited to HEDIS®, CAHPS® measures and Centers for Medicare & Medicaid Services (CMS) Star Ratings. We compiled the results for key clinical performance measures and the percentage of plans by rating.

Measuring member experience

We annually measure member experience using the CAHPS® survey tool. The most recent member satisfaction results showed improvements in:

  • Care coordination
  • Getting needed care
  • Claims processing

For Marketplace, we measure member experience using the Key Member Indicator (KMI) Survey and QHP Enrollee Survey. The most recent surveys showed improvements in:

  • Rating of health plan
  • Plan administration
  • Rating of health care

Measuring provider experience

We conducted a physician and practice manager satisfaction survey. Results from the most recent survey showed improvements in:

  • Overall service satisfaction
  • Ease of credentialing process
  • Ease of the prior authorization process
  • Ease of the appeal process

Efforts are underway to improve performance related to: 

  • Improving and simplifying the prior authorization process
  • Improving the efficiency and ease of physician-to-physician communications

Questions?

Please connect with your Provider Advocate.


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