Quality Improvement

We are committed to using a comprehensive approach to manage the quality of care and services that you receive from our providers. We constantly monitor and evaluate the quality of care and services provided to you.

We strive to deliver the best health outcomes and meaningful improvements in your health by working with your doctors, pharmacists and other healthcare providers to find opportunities for improvement. The quality of care your doctors, pharmacists and other specialists provide should meet recognized national and local community standards.

Universal American designed its Medicare Advantage Quality Improvement Program to meet the quality performance and improvement goals established by our Board of Directors as well as the requirements of licensing or regulatory agencies, including the Centers for Medicare & Medicaid Services (CMS) and state agencies. The Quality Improvement Program is built on the structure-process-outcome model of quality, employing the practice, Plan, Do, Check, Act (PDCA) cycle of continuous quality improvement. Quality improvement activities extend to all areas and dimensions of clinical and non-clinical member care and service.

The scope of the Quality improvement Program encompasses the member populations of all Universal American Medicare Advantage and Medicare Advantage Prescription Drug plans. It provides for continuous and ongoing monitoring and evaluation of care and services including:

• The quality of clinical care and the quality of services delivered.
• Member and provider satisfaction, special focus areas, development or adoption of clinical guidelines.
• Member and provider education.
• Research activities.
• Provider and professional credentialing.

In addition to continuously improving the quality of care you receive, we monitor and evaluate the programs we provide.  As such, the plan participates in an annual Healthcare Effectiveness Data Information Set (HEDIS) audit to measure our performance against nationally recognized measurements of care and to ensure the highest standards of care and service are met. The plan also reviews the results of its Consumer Assessment of Healthcare Providers and Systems (CAHPS) data to ensure the highest degree of member satisfaction. When any issues are identified, such as quality of care, quality of service, or satisfaction of our members, we work hard to fix them through our quality improvement process. The result of these ongoing and proactive activities is improved quality of care, better health outcomes for you, and greater levels of member satisfaction. If you have questions pertaining to the plan's Quality Improvement Program, please call Member Services at 1-866-547-3060, 8:00 a.m. to 8:00 p.m. in your local time zone (TTY users call 1-800-958-2692) 7 days a week.