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 1-888-348-2922

Aetna Better Health of West Virginia'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 like taking your child for their checkup
  • 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 and disease management
  • Giving members information on the website about what health care costs
  • 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 1-888-348-2922 to find out more about our quality programs. You can also ask for a written description of our Quality Management Program.

Our 2019 Quality Results

Aetna Better Health works hard to make sure you get the best health care and service. Each year we look at how well we are doing. We set goals for care and service.  If we don’t reach our goals we make a plan to help us improve and reach our goals in the future.

A tool called HEDIS® (Healthcare Effectiveness, Data and Information Set) helps us measure if our members are getting good health care. Below are some of the HEDIS® Results for measurement year 2018.

Areas where we met our goals:

  • Well care and Immunizations for Children and Adolescents
  • Childhood weight and physical activity counseling
  • Annual dental visits
  • Management of chronic conditions such as diabetes, hypertension and asthma

Areas where we did not meet our goals:

  • Cervical and Breast Cancer Screening for Women
  • Management of Low Back Pain

We also conduct a member satisfaction survey each year. The survey is called CAHPS®. There is an adult survey and a child survey. The results from the survey help us:

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

Below are some of the 2019 CAHPS Survey Results.

Areas where we met our goals:

  • Rating of Specialist Doctor (adult)
  • Customer Service (both)
  • Getting Needed Care (child)
  • Getting Care Quickly (both)

Areas where we did not meet our goals:

  • Rating of Personal Doctor (both)
  • Rating of Health Plan (both)
  • Rating of Health Care (both)
  • Rating of Specialist Doctor (adult)
  • Getting Needed Care (Adult)

We will continue to work hard to make sure you get the best health care and service!

Your voice matters!

If you get a member satisfaction survey, please take the time to complete it. We do our best to earn the highest scores (9 or 10) from our members. If you are not happy with your health care or service, please let us know. Call Member Services at 1-888-348-2922.