Our Tennessee Quality Management program
Last update: February 4, 2021
United Healthcare Community Plan wants you to get the best care and service. That’s why we have a Quality Management (QM) program. Our QM program helps us learn what we can do better. Then we use it to improve. Our QM program has several member health programs.
These programs:
- Help people with health conditions like asthma, diabetes, heart disease, depression, bipolar disorder and schizophrenia
- Help pregnant women have healthy babies
- Help people stay healthy with shots, screenings, and tests
- Improve patient safety
- Make sure members are happy with the plan
- Make sure doctors and other health care professionals meet our standards
We use national standards to see how well our QM program works. The National Committee for Quality Assurance (NCQA) writes the standards. NCQA is an independent agency. It compares the quality programs of health plans. We measure our progress meeting our goals using NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) Consumer Assessment of Healthcare Providers & Systems (CAHPS®). HEDIS® and CAHPS® results are given in a national report card. Below you will find our 2020 TennCare HEDIS® and CAHPS® highlights. The box compares our results to national averages:
2020 Adult CAHPS® Highlights |
|||||
MEASURE |
United HealthCare Community Plan Middle TN |
United HealthCare Community Plan East TN |
United HealthCare Community Plan West TN |
HEDIS® 2020 National 50th percentile** |
|
Rating of Health Plan* |
69.4% |
70.9% |
69.1% |
62.8% |
|
Rating of Personal Doctor* |
72.1% |
72.5% |
70.1% |
69.7% |
|
Rating of all Health Care* |
63.0% |
57.8% |
57.8% |
57.6% |
|
Rating of Specialist* |
65.9% |
70.5% |
69.7% |
70.4% |
|
How Well Doctors# Communicate |
92.9% |
92.4% |
90.7% |
93.4% |
|
2020 ChildÇ CAHPS® Highlights-General Population |
|||||
Rating of Health Plan* |
80.6% |
80.1% |
76.7% |
73.3% |
|
Rating of Personal Doctor* |
83.3% |
82.1% |
85.0% |
79.0% |
|
Rating of all Health Care* |
77.3% |
77.2% |
76.4% |
72.4% |
|
Rating of Specialist* |
N/A |
N/A |
N/A |
74.2% |
|
How Well Doctors# Communicate |
94.2% |
95.4% |
95.5% |
95.5% |
|
2020 HEDIS® Measures |
|
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Women’s Health: |
|
|
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Breast Cancer Screening |
54.24% |
57.39% |
54.97% |
58.8% |
|
|
Timeliness of Prenatal Care |
78.35% |
88.08% |
84.43% |
89.1% |
|
|
Postpartum Care |
72.99% |
77.62% |
68.86% |
76.4% |
|
|
Diabetes Care: |
|
|
||||
A1C Level Testing |
89.10% |
90.17% |
86.67% |
88.8% |
||
Retinal Eye Exam Performed |
55.86% |
54.45% |
53.99% |
58.6% |
||
Diabetic Blood Pressure Control <140/90 |
65.67% |
68.39% |
56.21% |
64.0% |
||
Monitoring for Kidney Disease |
90.46% |
91.77% |
91.76% |
90.1% |
||
Behavioral Health |
|
|||||
Antidepressant Medication Management - Effective Continuation Phase Treatment |
37.28% |
40.00% |
32.36% |
38.4% |
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ÇPopulation-eligible members were 17 years and younger, as of 12/31/2019.
*Percentage reflects members who rated their plan/provider 9 or 10 on a scale of 0-10, 10 being best.
N/A assigned when number of respondents total less than 100.
#Percentage reflects respondents indicating ‘always’ or ‘usually’.
**National Average is based on the HEDIS® 2020 NCQA 50th percentile.
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).
Learn more. If you would like to know more about our quality health programs, visit uhccommunityplan.com. A paper copy of our QM Program Description is available upon request. Please call Customer Services at 1-800-690-1606 for a copy.