Quality Initiatives

NCQA Accreditation

Each year since 2002, Network Health Plan has received an “EXCELLENT” accreditation status from the National Committee for Quality Assurance (NCQA) for its commercial HMO insurance plans. The NCQA is an independent, non-profit organization that assesses and reports on the quality of the nation’s managed health care plans. An accreditation status of Excellent, which is the highest possible level awarded by the NCQA, is based on a voluntary review of how the health plan ensures that its participants are receiving high quality medical care.

NCQA accreditation tells health plan members whether the care they receive and the physicians who provide that care meets or exceeds the industry’s highest quality standards. The NCQA accreditation process evaluates how well a health plan manages quality through every part of its health care delivery system, including physicians, hospitals, affiliated providers, and administrative services.

Margaret E. O’Kane, president of NCQA, has said that “achieving an accreditation status of “Excellent” is a significant achievement for a health plan. It is only awarded to those plans that meet or exceed NCQA’s rigorous requirements for consumer protection and quality improvement and have HEDIS results in the highest range of national performance.” HEDIS stands for Healthcare Effectiveness Data and Information Set and represents a standard data reporting method used by health plans to measure and compare performance on multiple dimensions of health status and service levels.

The NCQA Accreditation survey process includes on-site and off-site evaluations of more than 60 standards and selected HEDIS® performance measures conducted by a national team of physicians and managed health care experts. A committee of physicians then analyzes the team’s finding and assigns an accreditation level based on the performance level of each health plan compared to NCQA’s standards.

Quality Improvement Plan

The goal of Network Health Plan’s Quality Improvement Plan is to improve the quality of health care services received by its members and participants from health care providers. The Plan is updated annually and tracks a wide variety of measurement activities and improvement initiatives.

If you are interested in learning more about this Quality Improvement Program, please contact Network Health Plan’s Quality Improvement department at (920) 720-1655, or (800) 826-0940, extension 01655.

Checkpoint for Hospital Quality

The mission of CheckPoint is to develop consumer-focused initiatives that will provide reliable, valid measures of health care in Wisconsin to aid the selection of quality health care and quality improvement activities within the hospital field. Many Wisconsin hospitals have volunteered to provide information about the quality and safety of care they provide to their patients. An important aspect of CheckPoint is to educate the public on the type of interventions to be expected from their providers and why these interventions are important to them.   

Please visit the Wisconsin Healthcare Association CheckPoint website to learn more about the purpose of this initiative and to review the results from participating hospitals.