Member Satisfaction/Quality of Care

We monitor member satisfaction by participating in the nationally-standardized member satisfaction survey, known as CAHPS. This survey is conducted annually.

What is CAHPS?

The Agency for Healthcare Research and Quality and the National Committee for Quality Assurance (NCQA) have developed a health plan member survey called the Consumer Assessment of Healthcare Providers and Systems (CAHPS). CAHPS is a tool for measuring health plan member satisfaction. It asks questions about claims processing, customer service and health care services. This standardized tool gathers information from members so health plans around the country can compare performance. Health plans work to achieve a five-star rating on a scale of 1 to 5. 

For 2018, Prevea360 Health Plan scored a 4 or 5 on the following Commercial member satisfaction survery questions:

Member Satisfaction Survey CAHPS Star Rating
Coordination of care 5
Rating of care 5
Rating of primary care doctor 5
Rating of specialists 4
Rating of health plan 4

Quality of Care

We monitor quality of care through a nationally-standardized set of measures referred to as the Healthcare Effectiveness and Data Information Set (HEDIS).

What is HEDIS?

HEDIS was created by the NCQA to provide employers, individuals and families with information that allows them to compare the performance of different health plans. More than 90 percent of all health insurance companies utilize HEDIS as a trusted source of standardized measures. The NCQA is an independent, not-for-profit organization that evaluates health plans based on more than 50 standards of care and service to determine each health insurance company’s accreditation status.

What are ratings?

The NCQA uses star ratings to help consumers easily compare health insurance plans based on quality of care and service. The Centers for Medicare and Medicaid Services (CMS) also uses ratings to help consumers compare health insurance plans based on each plan’s quality standing. NCQA and CMS are industry-recognized organizations who monitor and report on the quality efforts of health insurance plans throughout the nation.

For 2018 Prevea360 Health Plan was rated a 4 or 5 on the following Commercial quality measures:
Childhood immunizations 4
Adolescent immunizations 5
Prenatal care 5
Postpartum care 5
Breast cancer screening 4
Colorectal cancer screening 5
Cervical cancer screening 4
Diabetes - Blood pressure control 5
Diabetes - Eye exams 5
Diabetes - Glucose control 5
Heart disease - Controlling high blood pressure 5
Depression - Adhering to medications 5
Appropriate antibiotic use, adults with acute bronchitis 4
Appropriate testing and care for children with a sore throat 4
Steroid after hospitalization for acute COPD 4
Bronchodilator after hospitalization for acute COPD 4
Use of imaging studies for low back pain 4