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

 

Women’s Health:

 

 

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%

             

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.