Listening to and acting on feedback
Feb. 2023Important Notices
Our goal is to provide our members with access to high-quality care. As a partner in care, you are key in helping us achieve this goal. Surveys give us actionable information that can help improve our members’ health care experiences and promote a high level of care.
Gathering feedback
Every year, UPMC Health Plan members provide anonymous feedback on their health care experiences in these ways:
Marketing accreditation requirements
These surveys are required to maintain ratings and accreditations:
Reviewing the results1
While we know that you provide excellent care to our members, there are always areas for improvement. The answers to these questions from the 2022 CAHPS surveys identify these opportunities.
Case coordination
Getting care quickly
Getting needed care
Annual flu vaccine
Find care options
It is important for our members to get the right care at the right time. You can help by encouraging them to use our new text messaging Care Finder program. Members can text “SERVICES” to 478-762 to learn about UPMC AnywhereCare visits, talk to a nurse through the UPMC MyHealth 24/7 Nurse Line, or work with the Prescription for Wellness team to make healthy lifestyle changes.
To view the CAHPS survey for each line of business1, please visit these websites:
As always, thank you for making outstanding care a priority.
1Please note that the CAHPS survey varies slightly depending on the member’s insurance plan. For example, the survey for individual plan members is different from the survey for Medicaid members.
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
Gathering feedback
Every year, UPMC Health Plan members provide anonymous feedback on their health care experiences in these ways:
- The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey for Commercial, Medicaid, Medicare, and CHIP members
- The Qualified Health Plan Enrollee Experience survey (QHP) for Marketplace members
Marketing accreditation requirements
These surveys are required to maintain ratings and accreditations:
- National Committee for Quality Assurance (NCQA) accreditation
- NCQA ratings
- Centers for Medicare and Medicaid Service (CMS) star ratings
Reviewing the results1
While we know that you provide excellent care to our members, there are always areas for improvement. The answers to these questions from the 2022 CAHPS surveys identify these opportunities.
Case coordination
- How often did your doctor have your medical records or other information about your care?
- How often did you get test results as soon as you needed them?
- How often did someone from your personal doctor’s office follow up with test results?
- How often did you and your personal doctor talk about all the prescription medicines you were taking?
- Did you get the help you need from your personal doctor’s office to manage your care among these different providers and services?
- How often did your personal doctor seem informed and up to date about care you got from specialists?
Getting care quickly
- When you needed care right away, how often did you get care as soon as you needed?
- When you made an appointment for a check-up or routine care at a doctor’s office or clinic, how often did you get an appointment as soon as you needed?
Getting needed care
- How often was it easy to get the care, tests, or treatment that you needed?
- How often did you get an appointment to see a specialist as soon as you needed?
Annual flu vaccine
- Have you had a flu shot since July 1?
Find care options
It is important for our members to get the right care at the right time. You can help by encouraging them to use our new text messaging Care Finder program. Members can text “SERVICES” to 478-762 to learn about UPMC AnywhereCare visits, talk to a nurse through the UPMC MyHealth 24/7 Nurse Line, or work with the Prescription for Wellness team to make healthy lifestyle changes.
To view the CAHPS survey for each line of business1, please visit these websites:
- Commercial: upmchp.us/CAHPSCM
- UPMC for You, adult: upmchp.us/CAHPSMAad
- UPMC for You, child: upmchp.us/CAHPSMAchild
- UPMC for Kids: upmchp.us/CAHPSKids
- UPMC for Life: upmchp.us/CAHPSMC
- UPMC Community HealthChoices: upmchp.us/CAHPSCHC
- Marketplace: upmchp.us/CAHPSQHP
As always, thank you for making outstanding care a priority.
1Please note that the CAHPS survey varies slightly depending on the member’s insurance plan. For example, the survey for individual plan members is different from the survey for Medicaid members.
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
Recent Announcements
Pause in Prior Authorization Policies
On April 1, 2025, we announced that UPMC Health Plan would start requiring prior authorization for certain services. Please note that we are delaying or changing the implementation of prior authorization for some of these services, as described below.May 2025Important Notices
May is Mental Health Awareness Month
“Turn Awareness into Action”Mental Health America founded Mental Health Month in 1949, and since that time, every May has been a time to unite millions of people to promote awareness, provide vital resources, and advocate for everyones mental well-being. 1 in 5 people will experience a mental health condition in any given year¹. Mental health affects us all, and its critical that we move beyond awareness to take meaningful steps for our well-being and that of our community.May 2025Important Notices
Special notice: Important policy changes
Effective June 1, 2025, UPMC Health Plan will be implementing policy changes that will require providers to obtain prior authorizations for services listed in the following policies. For more information, please visit upmchp.us/policiesandprocedures.May 2025Important Notices