Advancing quality

Our unwavering commitment to quality is rooted in our vision for an innovative, whole-person, well-coordinated system of care that addresses both medical and non-medical drivers of health and promotes health equity. Quite simply, we expect more—from ourselves and for our members, communities, and all stakeholders we serve.

Multiple NCQA recognitions

 

The National Committee for Quality Assurance (NCQA) is an independent, not-for-profit organization recognized as a national leader for improvements in health care standards, programs, and quality measurement. Wellpoint proudly holds multiple NCQA accreditations as evidence of our commitment to quality.

Each one of our Wellpoint markets holds NCQA Health Plan Accreditation, evidence of our commitment to quality in member experience, clinical performance, and network management.

Wellpoint affiliates in four states achieved a 4.0/5.0 rating from NCQA for 2019-2020, placing them in the top quarter of Medicaid health plans.

Wellpoint has earned Multicultural Health Care Distinction status from NCQA, a recognition of our commitment to providing culturally and linguistically appropriate services and reduction in health care disparities to our Medicaid members.

At the national level of Wellpoint’s parent company, the Medicaid division holds:

  • NCQA Managed Behavioral Health Organization accreditation, an acknowledgment of the effectiveness of our integrated care model.
  • NCQA accreditation for nine Disease Management programs, a recognition of the quality supports and services we offer members who are living with a health condition.

88% of our current LTSS members are enrolled in health plans that have obtained NCQA LTSS Distinction.

Strong quality measure results

  

NCQA uses numerous quality measures known as the Healthcare Effectiveness Data and Information Set (HEDIS®). A few of our Maryland health plan rankings for calendar year 2021 include:

  • 90th percentile for HbA1c 
  • 90th percentile for Immunizations for Adolescents 
  • 75th percentile for Timeliness of Prenatal Care
  • 75th percentile for Postpartum Care
  • 75th percentile for Breast Cancer Screening

High rates of member satisfaction

  

The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) program surveys member experience with a health plan and how well the plan is meeting member expectations. For reporting year 2022, our Maryland health plan rated:

  • 3 Stars for the Child Survey results
  • 4 Stars for overall health plan

Changing the health care landscape

  

As a leader in value-based payment (VBP) programs, we are partnering with providers to change the health care landscape. We believe the most effective way to align quality and performance outcomes to optimize value is the overlay of our VBP programs with state-specific provider reimbursement strategies that focus on the evolving needs of the State and our members to create healthier communities.

About 55% of Wellpoint and its affiliated Medicaid health plans’ members are attributed to a primary care provider (PCP) or other provider who participates in one or more VBP models.

Since 2012, Wellpoint and its parent company’s affiliated health plans have reduced the number of opioid prescriptions filled by over 40%.

Learn more about what we do

 

Children and youth in foster care

 

Wellpoint and its affiliated plans coordinate care for more than 121,000 children, adolescents and young adults in foster care, adoption assistance, and juvenile justice programs across the country.

 

Explore our youth programs 

 

Community partnerships

 

Wellpoint seeks out new and better ways to improve member health outcomes, quality of life, and access to high quality, cost-efficient care and services.

 

Learn about our partnerships 

“I am very thankful that my family can get the help they need to keep them healthy. We all greatly appreciate what Wellpoint does for us and are glad to be a part of the Wellpoint family.”

 

– Megan, Wellpoint member

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

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).