Quality
Health Plan Quality Program Summary
Martin’s Point Health Care (Martin’s Point) strives to provide health plans that are among the best in the nation.
We are committed to supporting the delivery of care and service that meets the highest standards for safety, effectiveness, and customer experience.
We continually collect and analyze data to monitor our performance and identify areas for improvement. In collaboration with our network providers, we support effective and affordable screening and treatment practices to prevent health issues and manage chronic conditions.
Martin’s Point, along with nearly every health plan in the US, uses the Healthcare Effectiveness Data and Information Set (HEDIS®)1 to measure quality of care and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®)2 to measure member experience. Standard measures of clinical quality and customer experience allow individuals to compare health plans and make informed choices when it comes to selecting a health plan provider for themselves and their family members.
Health Plan Initiatives:
- HEDIS Electronic Clinical Data Systems (ECDS) Reporting
- Health Equity/Social Determinants of Health
- Navigator Team
- Population Health Management.
While Martin’s Point works to ensure the health of individual members, we are also concerned with the health of our overall member population and the well-being of our community. We offer an array of services including population health management, nursing care management, behavioral health care management, and perform a broad range of interventions targeted at groups of individuals who have care “gaps,” such as missing screening interventions, following clinical guidelines issued by nationally recognized expert bodies.
CAHPS Surveys
Martin’s Point uses the CAHPS® surveys to ask members about their experiences with the quality of care and customer service that we provide, i.e., health plans, prescription plans, and care providers.
The surveys focus on factors that members say are important to them, such as getting care easily and quickly, the quality of care provided by their primary care doctor or specialist, the coordination of their health care across the health care system, and overall service quality. When surveyed, our Martin’s Point health plan members continually exceed top benchmarks for member satisfaction.
TRICARE® US FAMILY HEALTH PLAN
QUALITY RATINGS
The National Committee on Quality Assurance (NCQA) has awarded the US Family Health Plan a health plan rating of:
4.5 out of 5 stars for quality performance in 2023—this includes earning a rating of 5 out of 5 for Patient Experience measures.
The overall rating is the weighted average of Martin’s Point Clinical quality measures from NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) and Consumer satisfaction measures using Consumer Assessment of Healthcare Providers and Systems (CAHPS®) measure ratings, plus bonus points for plans with a current Health Plan Accreditation status.
GENERATIONS ADVANTAGE
QUALITY RATINGS
Each year the federal agency that administers Medicare, the Centers for Medicare & Medicaid Services, rates all Medicare Advantage plans on quality and performance.
For 2024, our Generations Advantage HMO plans earned 4.5 out of 5 stars, including:
- Prime
- Alliance
- Value Plus
Our LPPO plan, Generations Advantage Select, earned 4.5 out of 5 stars.
NCQAs Health Plan Accreditation
The National Committee on Quality Assurance’s (NCQA) Health Plan Accreditation allows MPHC demonstrate our commitment to both service and clinical quality. NCQA standards provide a roadmap to improvement in multiple areas to keep members healthy:
- Quality Management and Improvement
- Population Health Management
- Network Management
- Utilization Management
- Credentialing and Recredentialing
- Members’ Rights and Responsibilities
- Member Connections
The National Committee on Quality Assurance (NCQA) has awarded the US Family Health Plan the accreditation status of Accredited in 2022. Martin’s Point will go through reaccreditation late in 2025.
About NCQA
The National Committee for 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 Health Plan Ratings evaluate health plans on the quality of care patients received, how happy the patients are with their care and health plans’ efforts to keep improving.
NCQA's website (https://www.ncqa.org/) contains information to help consumers, employers and others make more informed health care choices.
1.HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)
2.CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ)