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 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.

In addition to continuously improving the quality of care you receive, we make sure we monitor and evaluate the programs we, your health plan, provide, too. As such, the plan participates in an annual HEDIS audit (Healthcare Effectiveness Data Information Set) to ensure the highest standards of care and service are met. The plan also reviews the results of its Consumer Assessment of Health Plan Survey (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 call 713-558-4644.

Lastly, the plan has quality assurance and improvement policies and procedures in place for drug utilization review, medication therapy management, and pharmacy-related appeals and grievances.

Questions relating to the Medicare Advantage program should be directed to Customer Service 8:00 a.m. to 8:00 p.m. in your local time zone, every day.

TexanPlus HMO: 1-866-230-2513

TTY users call 1-800-958-2692