Quality Management & Improvement Efforts

Quality Improvement Strategy

We are working hard to improve the service, quality and safety of health care. One way we do this is by measuring how well we and others are doing.

We work with groups of doctors and other health professionals to make health care better.

Our clinical activities and programs are based on proven guidelines.

We also give you and your doctor information and tools to make decisions more confidently.

Program Goals

We aim to:

  • Meet our members’ health care needs
  • Measure, monitor and improve the clinical care our members get
  • Address racial and ethnic differences in health care
  • Make sure we obey all the rules, whether they come from plan employers, federal and state regulators, or accrediting groups
  • Make sure providers in our networks meet our standards

Program Scope

We work to make your health care better by:

  • Providing our members with clear information so they can make good decisions
  • Reviewing the health care services we cover and how care is coordinated
  • Encouraging providers to communicate with one another
  • Monitoring the effectiveness of our programs
  • Studying the accessibility of our network providers
  • Monitoring the overuse and underuse of services for our Medicare members
  • Performing credentialing and recredentialing activities
  • Assessing member and provider satisfaction

Program outcomes

Each year, we check to see how close we are to meeting our goals. Here's what we did in 2014:

  • We collected data on a set of clinical measures called the Healthcare Effectiveness Data and Information Set (HEDIS®*). We shared the results with the National Committee for Quality Assurance (NCQA) Quality Compass®.** The NCQA makes the results public. Each year, we use the results to set new goals and improve selected measures. As a result, performance has improved on many measures.
  • We asked members and providers how satisfied they are with Aetna. To improve satisfaction, we:
    • Enhanced the aetna.com website and online tools
    • Improved tools you can use to estimate how much you pay for health care, including the Price-a-DrugSM tool and Member Payment Estimator
    • Improved how we communicate with members
    • Enhanced our phone services and updated our provider on-line tools for improved workflow
  • We surveyed members in the Aetna Case Management program. They told us that their health had improved because of the program.1
  • We surveyed members in the Aetna Disease Management program. They told us that they learned valuable information and feel more productive at home or work because of the program.2
  • We also:
    • Improved our patient safety program
    • Used social media for patient safety communications
    • Provided information to physicians and members to help them make better decisions about medications
    • Made our Hospital Comparison Tool more useful

    • See hospital comparisons

Your behavioral health needs are important to us

We also monitor how well we’re doing meeting your behavioral – or mental – health needs. So in 2014, we took steps to improve our behavioral health plans. For example, we gave you and your providers more tools and information to help you take your medications as directed.

We made it possible for more members who are in the hospital to meet the behavioral health care professional who may care for them after they leave. We’ve added information online about the different types of behavioral health and substance abuse providers and the common conditions they treat.

 See our behavioral health information 


We take our accreditation by the NCQA seriously. It's how we show our commitment to improving your quality of care, access to care and member satisfaction.

Get more information about our NCQA accreditation

*HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
**Quality Compass is a registered trademark of NCQA.
1Based on results from the 2014 Aetna Case Management Member Satisfaction Analysis.
2Based on results from the 2014 Aetna Disease Management Member Satisfaction Analysis.


JavaScript is required

In order to have the best experience on Aetna.com, Javascript needs to be enabled.
Learn how to change your browser settings to enable Javascript.

You are now leaving the Aetna website

Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.

Continue >