Quality Improvement

Our Quality Improvement programs and information are developed, implemented, and evaluated to promote and preserve clinical excellence that fosters the safety and well-being of our members. 

At ConnectiCare, we feel so strongly about quality improvement that we have developed a quality incentive program designed to meet providers where they are today, making it easier to meet program participation requirements. See below for program qualifications and specifications that might fit your practice.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey helps us gain a better understanding of our members’ experiences when using their health care benefits so we can drive continuous improvement. Your interaction with our members has a direct impact on their response to the CAHPS survey.  Please access the documents to get further insight regarding CAHPS (including survey questions) and tips to ensure you provide the best care to your patients. 

The Medicare Health Outcomes Survey (HOS) provides a standardized understanding of patient outcomes around physical and mental health, fall risk and prevention, physical activity, and urinary incontinence. Our providers have a direct impact on patients’ perception of their health and quality of life. The tip sheet linked below offers techniques that may help providers enhance their Medicare patients’ health care outcomes.

The EmblemHealth Member Rewards Program gives members opportunities to be rewarded for taking good care of their health. Members who join the program can earn rewards for getting needed medical care such as their annual wellness visit, selected preventive screenings and more.

ConnectiCare is committed to helping our members stay healthy, get well, and live better lives. Our provider network plays an integral role in this effort, and we know you share the same commitment to delivering excellent care to your patients. As part of the ConnectiCare provider network, you have an opportunity to earn incentive payments for the work you do. Our Quality Incentive Program (QIP) focuses on measures that impact and improve important health outcomes for members. See attached pdf for specific program parameters and comprehensive information.

The Quality Measure Resource Guide provides a brief overview of national and state quality measures* that evaluate various domains of preventive, acute, and chronic care. We hope that you find this guide useful for the care of our shared members.

*Measures included in the guide are sourced from National Committee for Quality Assurance (NCQA) www.ncqa.org, and Centers for Medicare & Medicaid Services (CMS) https://www.cms.gov.

ConnectiCare’s primary concern is the quality of care our members receive in every setting, including skilled nursing facilities (SNFs). To aid members, families, and providers in the decision of choosing a SNF to meet their/their patient’s needs, we have compiled a list of our contracted SNFs with a Star Quality Rating of 3 and above.

We encourage you to provide EmblemHealth access to your patients’ medical records, supply supplemental data, and share nonstandard data to ensure we capture all needed information regarding your patients. You must provide EmblemHealth with access to medical records, at no charge, for quality reviews related to the Quality Incentive Program (QIP), as well as for Healthcare Effectiveness Data and Information Set (HEDISR) and other regulatory initiatives.

Telehealth uses technology to deliver cost-effective, convenient, high-quality care to ensure patients receive the right care, at the right place, and the right time. But did you know that telehealth can be leveraged to address gaps in care, maximize incentives and obtain the data needed for commercial, Medicaid, and Medicare health plan risk adjustment programs and value-based contract performance?