SPRJ43410 2019 NCQA Website Posting for AARP MAPD Plans R1 073018.indd

Transcript

1 For Quality Health Plans, ® You Can Count On UnitedHealthcare. UnitedHealthcare also works with the hospitals Choosing a health care may be a challenge. in our network to help improve patient safety. The details can be complex and you want to be sure you’re choosing a plan from a company The Leapfrog Group Hospital Quality and you can rely on. At UnitedHealthcare, we’re Safety Survey evaluates hospital performance always working to make our plans even better. based on quality and safety practices shown to affect patient safety. Read on to learn why you can have confidence in AARP® Medicare Advantage plans from UnitedHealthcare works with the Leapfrog UnitedHealthcare. Group and encourages our network hospitals to report to the Leapfrog Group Hospital Quality Our AARP plans are accredited by and Safety Survey. industry organizations. AARP plans are insured by UnitedHealthcare and are accredited by the National Committee for Quality Assurance (NCQA), a private For more information about nonprofit organization that is dedicated to patient safety, go online to improving health care quality. NCQA accredits the following websites: and certifies a wide range of health care organizations. It also recognizes clinicians and Leapfrog Group: 1 practices in key areas of performance. www.leapfroggroup.org We’re committed to patient safety. Joint Commission Patient Safety: http://www.jointcommission.org/ The National Patient Safety Foundation defines topics/patient_safety.aspx “patient safety” as “the prevention of health care errors, and the elimination or the reduction Agency for Healthcare 2 of patient injury caused by health care errors.” Research and Quality: At UnitedHealthcare, we work to help prevent www.ahrq.gov health care errors through our commitment to educating members and doctors, and through our support for evidence‑based medicine. We believe that members who have better information can make better decisions about their health. For example, our prescription drug plans provide up‑to‑date information to network pharmacists that can help them determine how a medication might interact with other medications you take.

2 • Cholesterol management The Leapfrog Group Hospital Quality and Safety Survey evaluates hospital performance based External • Chronic heart failure on four quality and safety practices shown to Resources • Chronic obstructive pulmonary disease affect patient safety: • Chronic stable angina • Computerized Physician Order Entry system • Depression (CPOE) — Staff members use computers to order medications, tests and procedures, and • Diabetes the computer system automatically checks the • Hypertension (high blood pressure) order for potential errors or problems • Oncology • Intensive Care Unit (ICU) staffing — ICUs • Preventive services are staffed by doctors and other health care professionals who have special training in • Substance use disorders, treatment of patients critical care You can request a paper copy of any of our • Evidence‑based hospital referrals — Referrals clinical guidelines by calling the Customer are generally made to specialty doctors and Service number on the back of your member hospitals that have experience with certain ID card. complicated conditions How we evaluate new technologies. • Leapfrog Safe Practices Score — Hospitals We want to make sure that medical tests that create procedures for avoiding medical and treatments are safe and effective for our mistakes while you’re in the hospital earn high members. At UnitedHealthcare, two groups Leapfrog Safe Practices Scores are responsible for reviewing clinical evidence Evidence-based clinical practice and deciding which tests and treatments will guidelines. be covered: Clinical Support Services and the UnitedHealthcare uses evidence‑based clinical Executive Medical Policy Committee. practice guidelines from nationally recognized The Executive Medical Policy Committee is sources to guide its quality and health made up of the following members: management programs. These guidelines are • UnitedHealthcare medical directors with a also available as a resource for our network range of different clinical specialties and providers. But all care decisions are made by subspecialties you and your doctor. • Clinical Support Services staff members The Executive Medical Policy Committee at • Leaders from our Legal Services, Consumer UnitedHealthcare reviews and approves our Affairs and Medical Claims Review clinical practice guidelines. The guidelines are reviewed annually, or whenever they change or departments as new clinical guidelines become available. • Guest physician specialists as needed We have clinical practice guidelines for the This committee reviews published clinical following conditions: evidence information from government • Acute myocardial infarction (heart attack, regulatory agencies and nationally accepted unstable heart) consensus statements to determine the safety and effectiveness of new technologies • Asthma and treatments. • Bipolar • Cardiovascular disease (heart disease)

3 The committee’s decisions are used to create We also routinely measure the quality of our medical policies that help UnitedHealthcare customer service: External medical directors, care managers, claims Resources • We want to be sure you get the help you may reviewers and others make informed and need when you call Customer Service, so we consistent determinations about which tests measure wait times for our customer service and medical treatments should be covered by calls. Our goal is to answer every call in 30 UnitedHealthcare plans. seconds or less and we continually train our staff so they can provide even better service Our Quality Improvement Program to you. may help improve your health care experience. • The doctors and other health care professionals in our network have the proper We’re proud of the plans we offer. But we’re credentials and qualifications. Last year, always working to make them even better. Our we exceeded our goal of completing the Quality Improvement Program helps us do that. credentialing process in less than 25 days. The Quality Improvement Program: If you would like a paper copy of our Quality • Works with your doctor and other health care Improvement Program, call providers to coordinate the information and , 1- 877- 699 - 5710 care options that may work best for you , 8 a.m. to 8 p.m. local time, 7 days 711 TTY a week. • Reminds and assists in scheduling the care and preventive screenings you may need How medical coverage decisions through various outreach efforts. In addition, it are made. addresses any barriers in getting the services Medical coverage decisions are based on you may need members’ coverage under their benefit plan • Provides information about the health and whether the care and service is appropriate outcomes and satisfaction of our members for the conditions. UnitedHealthcare follows and participating physicians and office Medicare coverage guidelines when making managers, and suggests ways to improve coverage decisions. UnitedHealthcare also offers preventive health The staff at UnitedHealthcare and the licensed programs with information and resources for professionals who make these decisions are help with depression, alcohol and drug abuse not offered financial incentives to encourage and addiction. For more information, call the inappropriate underutilization of care, services, Behavioral Health phone number on the back of or deny health care coverage to members. your member ID card. We’re pleased to report that many of our quality For information on the Quality measures have continued to improve year Improvement Program for your over year: specific health plan, call the The top measures with the highest level of Customer Service number on the improvement in 2018 are: back of your member ID card. • Adult BMI Assessment • Breast Cancer Screening • Colorectal Cancer Screening • Comprehensive Diabetes Care — Eye Exams and Monitoring for Neuropathy

4 In addition, you can always let us know how we Your satisfaction is very important to can improve specific plan experiences such as: us. Please tell us how we’re doing. External Resources • Communications about your benefits or Your opinion matters to us. Every year health topics UnitedHealthcare participates in a consumer satisfaction survey called the Consumer • Customer service Assessment of Healthcare Providers and • Getting approval for services or procedures Systems (CAHPS). This survey asks you to rate • Understanding how the plan pays your doctors the services provided by your health plan and and other health care providers your overall health care experience. • Finding out which pharmacies you can use, The Centers for Medicare & Medicaid Services which drugs are covered and how much you’ll (CMS) uses these results to monitor the quality pay for them of your health plan. CMS assigns health plans a • Knowing which doctors, hospitals or other Star Rating from one to five, with five stars being facilities you can use an excellent rating. This rating is based in part on members’ responses to this survey. How we protect your information. We encourage you to take the time to complete At UnitedHealthcare, your privacy is important the survey so we can continue to improve and to us. We have policies and procedures in place strive for excellence in getting you the health to protect the confidentiality of your information. care coverage and services that you may need. Please refer to your Evidence of Coverage Your feedback will help us provide the level of document for more information about protecting quality you deserve in a health plan. your personal health information. To tell us how we can improve your experience, or if you have any questions, simply call the Customer Service number on the back of your member ID card. 1 www.ncqa.org. 2 National Patient Safety Foundation. Our Definitions: patient safety. Chicago, Ill: National Patient Safety Foundation; http://www.npsf.org/for‑patients‑consumers/. AARP® Medicare Complete® Plans carry the AARP name. UnitedHealthcare Insurance Company pays royalty fees to AARP for the use of its intellectual property. Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan’s contract renewal with Medicare. Y0066_180720_032636 Accepted SPRJ43410

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