PHP continues to be a top-performing health plan. We consistently rank high in member satisfaction surveys, and we are accredited by a leading benchmarking program. While we are proud to receive such recognition, we take the greatest satisfaction in knowing that our focus on quality ultimately serves our members. Customer service is our highest priority, and we sincerely welcome feedback on our members’ healthcare experience.
Accreditation
The National Committee on Quality Assurance (NCQA) is a private, nonprofit organization dedicated to improving health care quality. NCQA Accredits and Certifies a wide range of health care organizations and recognizes clinicians in key clinical areas. NCQA’s HEDIS ® is the most widely used performance measurement tool in health care. NCQA’s website (www.ncqa.org) contains information to help consumers, employers and others make informed health care choices.
Physicians Health Plan (PHP) is accredited under NCQA’s Health Plan Accreditation standards for its Commercial/HMO and Health Insurance Marketplace products. PHP was rated 4 out of 5 stars in NCQA’s Commercial Health Plan Ratings 2022.
Quality Improvement Program
PHP’s Quality Improvement Program is based on a written description that we review and update annually. The description provides the integrated framework for all quality improvement activities and provides overall guidance to the activities of the various standing committees. The objective of the Quality Improvement Program is to promote both safety and excellence in care through continuous, objective assessment of important aspects of care/service, and the implementation of process improvements that are responsive to its members’ care needs, resulting in timely and sustained resolution of identified problems. The Quality Program is managed by deploying a continuous quality improvement (CQI) philosophy and mode of action focused on the specific needs of our members. The Plan-Do-Check-Act (PDCA) method of CQI is utilized to review and analyze defined measures of quality of care and service against desired performance goals allowing PHP to continuously promote and improve the structure process and outcomes of its health delivery system.
Structure
The Quality Improvement Program encompasses a system-wide approach to continuous quality assessment and improvement. It is integrated throughout the entire organization by means of standing committees with cross-functional representation and multidisciplinary teams. The structure is designed to promote integration and accountability toward achievement of the Quality Improvement Program goals. The PHP Board of Directors retains the authority, responsibility and accountability for PHP operations, including but not limited to the overall business plan and Quality Improvement and Utilization Management (UM) programs.
You may request more detailed information about PHP’s Quality Improvement Program by contacting the Quality Management Department at 517.364.8400.
HEDIS
PHP participates in HEDIS® (Healthcare Effectiveness Data and Information Set) reporting. HEDIS® is a set of standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed healthcare plans. It is sponsored, supported and maintained by the National Committee for Quality Assurance (NCQA) an independent, not-for-profit organization committed to evaluating and publicly reporting on the quality of managed care plans.