Quality Matters

It is important to us that you receive quality health care and customer service. Your satisfaction matters to us. The Quality Management (QM) program ensures our services meet high standards of quality and safety. We want to make sure you have:

  • The right kind of care
  • Easy access to quality medical and behavioral health care
  • Help with any chronic conditions or illnesses
  • Support when you need it most
  • High satisfaction with your doctors and with us

If you have a problem, please call Member Services at 1-855-364-0974 (TTY: 711) 24 hours a day, 7 days a week.

 

Aetna Better Health of Ohio’s Quality Management Program works to ensure that all of our services meet high standards of quality and safety. We have quality programs so that you can get the care you need. Some of our quality programs are:

  • Surveying members and providers to measure satisfaction
  • Calling members to remind them to get their care
  • Educating members by sending postcards or newsletters
  • Reviewing the type, amount and quality of services given to members
  • Working with members who have serious health issues through case management
  • Reminding providers and members about preventive health care
  • Measuring standards like how long it takes for a member to get an appointment
  • Monitoring phone calls to make sure your call is answered as quickly as possible and that you get correct information
  • Reviewing calls and complaints from members
  • Reviewing all aspects of the health plan with health plan staff, providers and members through committees

This list is just some of our quality programs. Call us at 1-855-364-0974 (TTY: 711) to find out more about our quality programs. You can also ask for a written description of our Quality Management Program.

HEDIS® and CAHPS® are a set of measures that help us to see how well our health plan performs.

2017 Quality Results

Aetna Better Health of Ohio works hard to give our members better care. Each year we report how well we are doing. We do this using a tool called HEDIS® (Healthcare Effectiveness, Data and Information Set).

Areas where we did better than last year:

  • Adult Access to Preventive/Ambulatory Health Services (AAP)
  • Care for Older Adults (COA) - Functional Status Assessment
  • Care for Older Adults (COA) - Medication Review
  • Care for Older Adults (COA) - Pain Screening
  • Comprehensive Diabetes Care (CDC) - BP Control (<140/90)
  • Comprehensive Diabetes Care (CDC) - Eye Exams
  • Comprehensive Diabetes Care (CDC) - HbA1c Control (<8.0%)
  • Comprehensive Diabetes Care (CDC) - HbA1c Poor Control (>9.0%) [Lower rate=better performance]
  • Controlling Blood Pressure (CBP)
  • Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET) - Engagement Rate
  • Pharmacotherapy Management of COPD Exacerbation (PCE) – Bronchodilator
  • Pharmacotherapy Management of COPD Exacerbation (PCE) - Systemic Corticosteroid
  • Plan all-cause readmission (PCR) - 18+ Rate [Lower rate=better performance]
  • Use of High Risk Medications in the Elderly (DAE) - 1 Prescription [Lower rate=better performance]

Areas where we can improve:

  • Adult BMI Assessment (ABA)
  • Antidepressant Medication Management (AMM) - Effective Acute Phase Treatment
  • Antidepressant Medication Management (AMM) - Effective Continuation Phase Treatment
  • Breast Cancer Screening (BCS)
  • Colorectal Cancer Screening (COL)
  • Comprehensive Diabetes Care (CDC) - Medical Attention for Nephropathy
  • Follow-up after Hospitalization for Mental Illness (FUH) - Follow-up within 30 days
  • Follow-up after Hospitalization for Mental Illness (FUH) - Follow-up within 7 days
  • Osteoporosis Management in Women Who Had a Fracture (OMW)
  • Persistence of Beta-Blocker Treatment After a Heart Attack (PBH)
  • Potentially Harmful Drug-Disease (DDE) - Total [Lower rate=better performance]

Aetna Better Health of Ohio works hard to deliver high quality service to our members. It is important that we measure how we are doing to make sure that we are meeting your needs. We conduct a member satisfaction survey each year. The survey is called CAHPS®. The results from the survey are used to help us:

  • Get feedback from members
  • Learn more about our members’ needs
  • Compare our service to other health care plans
  • Find ways to improve

An outside company (CSS Research) conducts the survey each year. CSS Research mailed 800 surveys to members. Here is what the survey told us:

Areas where we did better than 2015:

  • Pneumonia Shots
  • Member’s getting appointments and care quickly
  • Member’s rating of Customer Service
  • Member’s rating of health care quality

Areas where we can improve:

  • Annual flu vaccines
  • Care Coordination
  • Member’s rating of drug plan

Thank you for your feedback. If you get this year’s survey, please take the time to complete it. We will continue to work hard to offer you good health care and good customer service.

For more information call our Quality Improvement Department at 1-855-364-0974 (TTY: 711) 24 hours a day, 7 days a week.