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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 supports the development of patient-centered medical homes (PCMHs) to provide high quality primary care to our members.

The PCMH is a model of care that emphasizes care coordination and communication to transform primary care into what patients want it to be.

NCQA PCMH recognition is the most widely adopted model for transforming primary care practices into medical homes. Research confirms medical homes can lead to higher quality and lower costs and can improve patients’ and providers’ experience of care.

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.