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:
Getting needed care
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
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
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).