Quality

Health Plan Quality Program Summary

Martin’s Point Health Care (Martin’s Point) strives to provide health plans that are among the best in the nation. We are committed to supporting the delivery of care and service that meets the highest standards for safety, effectiveness, and customer experience. We continually collect and analyze data to monitor our performance and identify areas for improvement. In collaboration with our network providers, we support effective and affordable screening and treatment practices to prevent health issues and manage chronic conditions.

Martin’s Point, along with nearly every health plan in the US, uses the Healthcare Effectiveness Data and Information Set (HEDIS®)1 to measure quality of care and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®)2 to measure member experience. Standard measures of clinical quality and customer experience allow individuals to compare health plans and make informed choices when it comes to selecting a health plan provider for themselves and their family members.

While we work to ensure the health of individual members, we are also concerned with the health of our overall member population and the well-being of our community. We offer an array of services ranging from nursing care management to broad interventions targeted at groups of individuals who have care “gaps,” such as missed screening interventions. We follow clinical guidelines issued by nationally recognized expert bodies. Click to download Martin's Point Health Care Clinical Guidelines

We use the CAHPS surveys to ask members about their experiences with their health care, i.e. health plans, prescription plans, and care providers. The surveys focus on factors that members say are important to them, such as getting care easily and quickly, the quality of care provided by their primary care doctor or specialist, the coordination of their health care across the health care system, and overall service quality. When surveyed, our Martin’s Point health plan members continually exceed top benchmarks for member satisfaction.

Generations Advantage

Each year the federal agency that administers Medicare, the Centers for Medicare & Medicaid Services, rates all Medicare Advantage plans on quality and performance. For 2023, our HMO-plans—Generations Advantage Prime, Alliance, Value Plus, and Focus DC— and our LPPO plan Select earned Medicare's highest rating, 5 out of 5 Stars. Visit https://www.medicare.gov/find-a-plan/questions/home.aspx for more information.

US Family Health Plan

The National Committee for Quality Assurance (NCQA) has awarded the US Family Health Plan a rating of 4.5 out of 5 stars for quality performance in Maine; and 4 out of 5 star for quality performance in New Hampshire, New York, Pennsylvania, and Vermont as part of its Private Health Insurance Rating in 2022. This includes earning a rating of 5 out of 5 for Patient Experience measures. The overall rating is weighted average of a plan's HEDIS® and CAHPS® measure ratings, plus bonus points for plans with a current Accreditation status as of June 30, 2022. Learn more.

About NCQA

The National Committee for Quality Assurance (NCQA) is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations and recognizes clinicians in key clinical areas. NCQA's HEDIS® is the most widely used performance measurement tool in health care. NCQA's website (www.ncqa.org) contains information to help consumers, employers and others make more informed health care choices.

Visit http://healthinsuranceratings.ncqa.org/2019/search/Commercial/All/martin'spoint for more information.

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

2.CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ)