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Quality Management & Improvement Efforts

Quality improvement strategy

We are working hard to improve the service, quality and safety of health care. One way we do this is by measuring how well we and others are doing.

We work with groups of doctors and other health professionals to make health care better.

Our clinical activities and programs are based on proven guidelines.

We also give you and your doctor information and tools that may help you make decisions.

Program goals

We aim to:

  • Meet the members’ health care needs
  • Measure, monitor and improve clinical care and quality of service
  • Institute company-wide initiatives to improve the safety of our members and communities
  • Make sure we obey all the rules, whether they come from plan sponsors, federal and state regulators or accrediting groups

Program scope

We work to make your health care better by:

  • Developing policies and procedures that reflect current standards of clinical practice
  • Reviewing preventive and behavioral health services, and how care is coordinated
  • Addressing racial and ethnic disparities in health care that could negatively impact quality health care
  • Monitoring the effectiveness of our programs
  • Studying the accessibility and availability of our network providers
  • Monitoring the overuse and underuse of services for our Medicare members
  • Performing credentialing and recredentialing activities
  • Assessing member and provider satisfaction

Program outcomes

Each year we check to see how close we are to meeting our goals. Here's what we did in 2017:

  • We collected data on a set of clinical measures called the Healthcare Effectiveness Data and Information Set (HEDIS®1), as applicable. We shared the results with the National Committee for Quality Assurance (NCQA) Quality Compass®2. NCQA makes the results public. Each year, we use the results to set new goals and improve selected measures.
  • We asked member how satisfied they are with Innovation Health, and continued to implement actions to improve member satisfaction.
  • We noted an improvement in the coordination of member care.
  • We met the cultural and language needs of our members.
  • We improved our patient safety program to help our members make informed health choices.

1HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
2Quality Compass is a registered trademark of NCQA.

Your behavioral health needs are important to us

As the opioid crisis has continued to escalate, we remain vigilant in taking steps to address this issue. To help prevent addiction, we sent targeted mailings to prescribing providers to encourage appropriate prescribing practices. Mailings are also sent to members and providers to help coordinate care when multiple pain prescriptions involve more than one doctor. Our behavioral health clinicians continue to work to identify members at risk for opioid overdose and encourage the use of Naloxone, an emergency rescue medication and commercial member co-pays will be waived.

Additional Behavioral Health program improvements in 2017 include:

  • Established a monthly behavioral health Patient Safety Workgroup. The workgroup reviews quality of care trends and other patient safety issues. As a result, resolution times of Patient Quality of Care concerns were significantly reduced.
  • Televideo behavioral health services was made available.
  • Designed and implemented an annual survey of our network facilities. Initial results show overall satisfaction with the utilization management process to be 94%.

Our plans for 2018:

  • Applied behavior analysis team in place to better assist members in accessing autism services
  • Improve our precertification process for outpatient and inpatient care
  • Clinical Quality Improvement Activities for members with attention deficit hyperactivity disorder, depression and substance abuse diagnoses
  • Encourage broader use of televideo services
  • Continue to focus our efforts to help fight the opioid epidemic


We take our accreditation by the National Committee for Quality Assurance (NCQA) seriously. It's how we show our commitment to improving your quality of care, access to care and member satisfaction.

Get more information about our NCQA accreditation at


Innovation Health is a HMO, PPO plan with a Medicare contract. Enrollment in our plans depends on contract renewal. 

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

Innovation Health Medicare’s pharmacy network includes limited lower cost, preferred pharmacies in: Urban Mississippi, Urban Virginia, Rural Missouri, Rural Arkansas, Rural Oklahoma, Rural Kansas, Rural Iowa, Rural Minnesota, Rural Montana, Rural Nebraska, Rural North Dakota, Rural South Dakota, Rural Wyoming. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use.

For up-to-date information about our network pharmacies, including pharmacies with preferred cost sharing, members please call the number on your ID card, non-members please call 1-866-471-9374 (TTY: 711) or consult the online pharmacy directory at

Participating physicians, hospitals and other health care providers are independent contractors. They're neither agents nor employees of Innovation Health. The availability of any particular provider can't be guaranteed. Provider network make-up is subject to change. 

       Y0123_4006_14184_M Accepted 9/2018

       Page last updated: May 31, 2019

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