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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 give you and your doctors information and tools that may help you make decisions.

Program Goals

We aim to:

  • Meet the members’ health care needs
  • Measure, monitor and improve the clinical care and quality of service our members get
  • Institute company-wide initiatives to improve the safety of our members and communities
  • Make sure we obey all the rules, whether they come from plan sponsors, federal and state regulators, or accrediting groups

Program Scope

We work to make your health care better by:

  • Developing policies and procedures that reflect current standards of clinical practice
  • Reviewing preventive and behavioral health services, and how care is coordinated
  • Addressing racial and ethnic differences in health care
  • Monitoring the effectiveness of our programs
  • Studying the accessibility and availability 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 2015:

  • We collected data on a set of clinical measures called the Healthcare Effectiveness Data and Information Set (HEDIS®*), as applicable. 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 
    • Enhanced our phone services and updated our provider on-line tools for improved workflow
    • Implemented a comprehensive call quality program that focuses on accuracy, core values and engagement for member calls
  • We surveyed members in the Aetna Case Management program. They told us that the program has helped them better manage their health.1
  • We surveyed members in the Aetna Disease Management program. They told us that the program helped them learn the importance of taking medication as prescribed.2
  • We also:
    • Improved our patient safety program
    • Used social media for patient safety communications to our members
    • Provided information to physicians on patient safety in the ambulatory setting
    • Made our Hospital Comparison Tool more useful by adding patient experience survey information

    • 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. Members told us that they are more satisfied with their behavioral health services, and that finding the right mental health provider became easier. And in 2015, 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 discharged from the hospital to connect with the behavioral health care professional who may care for them after they leave. We began a program to help save lives due to accidetal opioid overdoses, and increased outreach to members with extensive behavioral health needs.

 See our behavioral health information 

Accreditation

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 2015 Aetna Case Management Member Satisfaction Analysis.
2Based on results from the 2015 Aetna Disease Management Member Satisfaction Analysis.

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