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Quality Improvement

High-quality health care is a top priority at UPMC Health Plan.

That’s why we uphold a unique partnership with our providers, one that combines delivery of health care with financial accountability. We meet with hospital CEOs to review outcomes and compare performance across the network. Then, we work together on action plans for overall service improvements.

We believe that if we give doctors the right information, they will make the right choices. We continually supply clinical education tools and guidelines to help doctors streamline costs while delivering top-quality care.

Our Quality Improvement Program, in collaboration with providers in the Health Plan network, operates according to guidelines established by the National Committee for Quality Assurance (NCQA).

If you would like more information about our Quality Improvement Program, or if you have suggestions for enhancing our Quality Improvement Program, please contact:

Quality Improvement
UPMC Health Plan
U.S. Steel Tower
600 Grant Street
Pittsburgh, PA 15219

Our Quality Improvement Program

NCQA Health Plan Accreditation

NCQA's health plan accreditation is built on more than two decades of experience. NCQA's dedication to comprehensive research and quality has helped improve the managed care experience for health plans, patients, physicians, and employers. Recognizing hundreds of plans that cover more than 136 million people (43 percent of the U.S. population), NCQA is the most widely recognized accreditation program in the United States. NCQA accreditation is the most comprehensive evaluation in the industry and the only assessment that bases results on clinical performance (HEDIS measures) and consumer experience (CAHPS measures).

Medicare Stars

UPMC consistently earns top ranking in the Medicare Quality Rankings.

Medicare evaluates plans based on a 5-Star rating system. Star ratings are calculated each year and may change from one year to the next.

Healthcare Effectiveness Data and Information Set (HEDIS) Data

HEDIS measures quality of care and service on important health issues. Because more than 90 percent of America's health plans use HEDIS data, it provides consumers with an "apples-to-apples" comparison of health plans' performance.

Quality Compass provides consumers, benefits managers, health plans, consultants, and the media with easy access to comprehensive information about health plan quality and performance.

For more information on Quality Compass and health plan report cards, visit NCQA.

Patient-Centered Medical Home

UPMC Health Plan has been designated an NCQA Partner in Quality. NCQA designates organizations as Partners in Quality when they provide qualifying financial incentives or support services to practices seeking NCQA Recognition, at no cost to the practice. Partners in Quality receive a 20 percent Recognition initial application discount to offer participating practices. UPMC Health Plan supports NCQA’s Patient-Centered Medical Home (PCMH), Patient-Centered Specialty Practice (PCSP) and Patient-Centered Connected Care (PCCC) Recognition programs. Additionally, UPMC Health Plan will cover the full cost of the initial application recognition fee for these programs. To learn more about this opportunity, please contact UPMC Health Plan at 1-866-918-1595.

Innovative Research

UPMC Center for High-Value Health Care

UPMC is a top provider of medical care, and through its UPMC Insurance Services Division the company provides commercial and public health care insurance services including behavioral health and a range of employee solutions such as employee assistance programs. The UPMC Center for High-Value Health Care translates the work of this unique payer-provider laboratory into evidence-based practice and policy change for improving health care quality and efficiency. Many Center activities are supported through grants and contracts and conducted in partnership with community organizations and government agencies.