Quality Highlights
Our Quality Improvement Program (QIP) supports our mission to deliver direct access to high-value, personalized health care that aims to improve your health and well-being through all your health care needs. QIP drives organizational improvement for excellence through efficiencies, increasing the competitive advantage, and building trust and recognition in the community to improve the health status, safety and satisfaction of our members.
QIP is the framework for a formal process to assess our performance by monitoring and evaluating the quality of member care. This approach enables us to focus on issues of appropriateness, efficiency, safety as well as health outcomes and satisfaction of our members and their providers. This is achieved by monitoring our performance according to, or in comparison with, objective measurable performance standards. QIP promotes accountability and identifies issues that impact our ability to better our performance and improve health care and services provided to our members.
We annually review our QIP structure and develop a work plan to define quality-related planning and monitoring of activities as well as clinical and operational improvement. We also regularly evaluate our activities, analyze progress toward our goals and identify new focus areas and goals. We evaluate our QIP annually to make sure it is effective and meaningful to meet regulatory standards and guidelines.
Medicare Star Ratings
Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans on a 5-star rating system, five stars being the highest. These Star Ratings are awarded each year and may change from one year to the next. Stars are awarded based on how a health plan services you and supports your health. Star Ratings are based on five health service categories:
- Keeping members healthy through preventive screenings, vaccines and other checkups
- Managing chronic (long-term) conditions
- Member satisfaction with their health plan, drug plan and provider
- Operational performance
- How well plans handle member requests
Aspirus Health Plan’s Medicare Advantage plans do not have Star Ratings yet, though we are still working with our members in staying healthy and ensuring satisfaction with health care and health plan services received.
Why do Star Ratings matter?
Star Ratings can be used as a tool to tell which plans in your area are top performers. A plan with a 4-star rating or higher is considered an above average plan. You can use Star Ratings to compare our plan’s performance to other plans to find the one that best meets your needs. You can look up plans and review their ratings on medicare.gov.