Quality Management & Improvement Activities

The quality and safety of your health care matter most

We’re working hard to improve the quality and safety of your health care. We do this by:

•        Measuring how well we’re doing

•        Working with doctors and other health professionals

•        Using proven guidelines as the basis for our clinical programs

•        Giving you and your doctors better decision-making tools

You’re at the center of our quality program

Your health care can sometimes get very complicated. How your doctors talk with you and each other can make a difference. We look at the health care you get and how you get it – so we can set goals to make things easier.

Some of the things we do to help you get the best care from your doctors are:

•        Making sure you have a choice of doctors in your community

•        Checking doctors’ credentials on a regular basis

•        Asking them to keep organized records about your care

•        Encouraging them to talk with each other about what they’re doing for you

We not only want you to get care by the right person, but also the right care at the right time. Our coverage polices are reviewed often to make sure they are up to date. We look at which services you’re not using enough, or using too much. We also find ways to help you get care that is right for you regardless of your race or ethnicity.

Here’s how we met our program goals

Each year, we check to see how much we’ve improved the quality and safety of your health care. In 2013, we asked you and your doctors how satisfied you were with us.

Based on what you told us in terms of quality, we’ve made our website easier to use. We’ve also given you several tools to help you make better decisions about your health care, including:

  • RelayHealth, to help you talk to your doctors privately, online
  • Price-a-Drug, to help you estimate how much you might pay for prescription medications

  • As for your safety, we’ve made our hospital comparison tool better. And, you can check which hospitals get good grades for safety. Just select the “Leapfrog Hospital Safety Scores” link in our online directory, DocFind®.

We wanted you to know about the risks of scheduling to have your baby before you’ve reached 39 weeks of pregnancy. So we worked with the March of Dimes® and several health plans to get the word out.

We’re using social media more to talk to you about patient safety. And we’re giving you and your doctor information so you can make better decisions about the drugs you take.

Your mental health needs are also top of mind

We also monitor how well we’re doing meeting your behavioral – or mental – health needs. So in 2013, we took steps to improve our behavioral health plans. For example, we gave you and your doctors more tools and information to ensure that you’re taking drugs as directed.

We made it possible for more members who are in the hospital to meet the doctor who will care for them after they leave. And we’ve improved patient safety training for all behavioral health staff.

You stand to win when we get high marks

Every year, we’re rated by the National Committee for Quality Assurance (NCQA). The NCQA is an independent, nonprofit group. Their goal is to improve health care quality. They created a set of measures called the Healthcare Effectiveness Data and Information Set (HEDIS®).* These measures are used to rate health plans. They rate quality of care, access to care and member satisfaction. More than 90% of America’s health plans use these measures, including Aetna.

We take our NCQA ratings seriously. They help us learn new ways to improve what we do so we can meet your needs.

See more information about our NCQA ratings 

And you can get more information about our NCQA accreditations on the NCQA website.

Visit the NCQA website

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

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna).

This material is for information only. For more information about Aetna, please refer to www.aetna.com.


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