Quality

Nothing matters more to Arise Health Plan than providing quality service to members. Our guiding principle is to provide services that are safe, timely, effective, efficient, equitable, and member-centered. We’re dedicated to maintaining an active quality improvement program that includes both clinical and service quality initiatives.

Quality Improvement

The National Committee for Quality Assurance (NCQA) measures quality and performance using two tools: CAHPS® (Consumer Assessment of Healthcare Providers & Systems) and HEDIS® (Healthcare Effectiveness Data & Information Set).

CAHPS® is a member satisfaction survey used to evaluate the experience a patient has with a health care organization. By measuring the patient-centeredness of care, CAHPS® helps organizations assess and improve quality.

We are proud of our recent results and continue to strive toward our goal of exceeding the 90th percentile nationally.

Click on the blue tabs below and view our recent results.

2015 CAHPS® Performance Data

Health Plan

Health Plan

Percentage of members rated Arise Health Plan as an 8, 9, or 10 on a scale of 0-10 with 0 meaning the worst possible and 10 meaning the best possible

Arise Health Plan: 61.77%
 
 
National Average: TBD
Health Care

Health Care

Percentage of members rated their health care as an 8, 9, or 10 on a scale of 0-10 with 0 meaning the worst possible and 10 meaning the best possible

Arise Health Plan: 79.26%
 
 
National Average: TBD
Personal Doctor

Personal Doctor

Percentage of members rated their primary care physician as an 8, 9, or 10 on a scale of 0-10 with 0 meaning the worst possible and 10 meaning the best possible

Arise Health Plan: 84.88%
 
 
National Average: TBD
Specialist

Specialist

For those members who needed specialty care, the percentage of members who rated their specialist as an 8, 9, or 10 on a scale of 0-10 with 0 meaning the worst possible and 10 meaning the best possible.

Arise Health Plan: 81.87%
 
 
National Average: TBD
Shared Decision Making

Shared Decision Making

Percentage of members responded that their doctor discussed pros & cons of treatment choices and asked what treatment choice was best for the member

Arise Health Plan: 83.22%
 
 
National Average: TBD
Doctors Communicate

Doctors Communicate

Percentage of members responded usually or always their personal doctor's explanation of things was easy to understand, showed respect for what the member had to say and spent enough time with the member

Arise Health Plan: 96.27%
 
 
National Average: TBD

Getting Needed Care

Getting Needed Care

Percentage of members responded it was easy to get the care, tests, or treatments needed and to get appointments with specialists

Arise Health Plan: 92.65%
 
 
National Average: TBD
Getting Care Quickly

Getting Care Quickly

Percentage of members responded they got urgent care as needed, got regular/routine appointments as soon as needed

Arise Health Plan: 86.66%
 
 
National Average: TBD
Smoking-Tobacco Use

Smoking-Tobacco Use

Medical assistance with smoking and tobacco use cessation

Arise Health Plan: 11.83%
 
 
National Average: TBD
Flu Shot - Adults

Flu Shot - Adults

Members aged 50 to 64 who received a flu shot

Arise Health Plan: 38.65%
 
 
National Average: TBD
Claims Processing

Claims Processing

Percentage of members responded that claims were usually or always handled quickly and correctly

Arise Health Plan: 89.97%
 
 
National Average: TBD
Customer Service

Customer Service

Percentage of members responded that they usually or always received needed information from Member Services and that they were treated with courtesy and respect.

Arise Health Plan: 89.82%
 
 
National Average: TBD

2015 HEDIS® Performance Data

HEDIS® compares the performance of different health plans on a broad range of important health issues. This information helps employers, individuals, and families determine which plan may be best for them.

Click on the blue tabs below and view our recent results.

2015 HEDIS® Customer Service

Call Timeliness

Call Timeliness

Percentage of calls received by the health plan that were answered by a live voice within 30 seconds

Arise Health Plan: 68.66%
 
 
National Average: TBD

2015 HEDIS® Access to Care

Children (12 to 24 mo)

Children (12 to 24 mo)

Percentage of members who had a visit with a Primary Care Practitioner

Arise Health Plan: 97.58%
 
 
National Average: TBD
Children (25 mo to 6 yrs)

Children (25 mo to 6 yrs)

Percentage of members who had a visit with a Primary Care Practitioner

Arise Health Plan: 94.02%
 
 
National Average: TBD
Children (7 to 11 yrs)

Children (7 to 11 yrs)

Percentage of members who had a visit with a Primary Care Practitioner

Arise Health Plan: 91.97%
 
 
National Average: TBD
Children (12 to 19 yrs)

Children (12 to 19 yrs)

Percentage of members who had a visit with a Primary Care Practitioner

Arise Health Plan: 86.95%
 
 
National Average: TBD
Adults (20 to 44 yrs)

Adults (20 to 44 yrs)

Percentage of members who had a visit with a medical practitioner

Arise Health Plan: 92.2%
 
 
National Average: TBD
Adults (45 to 64 yrs)

Adults (45 to 64 yrs)

Percentage of members who had a visit with a medical practitioner

Arise Health Plan: 94.48%
 
 
National Average: TBD
Adults (age 65+)

Adults (age 65+)

Percentage of members who had a visit with a medical practitioner

Arise Health Plan: 98.56%
 
 
National Average: TBD

2015 HEDIS® Behavioral and Mental Health

7 Day Follow Up

7 Day Follow Up

Follow Up After Hospitalization for Mental Illness within 7 days

Arise Health Plan: 36.84%
 
 
National Average: TBD
30 Day Follow Up

30 Day Follow Up

Follow up after hospitalization for mental illness within 30 days

Arise Health Plan: 84.21%
 
 
National Average: TBD
Acute Medication

Acute Medication

Percentage of members diagnosed with major depression who remained on an antidepressant medication for 84 days

Arise Health Plan: 71.79%
 
 
National Average: TBD
Continuation Medication

Continuation Medication

Percentage of members diagnosed with major depression who remained on an antidepressant medication for 180 days

Arise Health Plan: 53.85%
 
 
National Average: TBD
Treatment Initiation

Treatment Initiation

Percentage of members diagnosed with alcohol or other drug dependence who received treatment within 14 days of diagnosis.

Arise Health Plan: 27.59%
 
 
National Average: TBD
Treatment Engagement

Treatment Engagement

Percentage of members diagnosed with alcohol or other drug dependence who received additional services within 30 days after initial visit

Arise Health Plan: 10.34%
 
 
National Average: TBD

2015 HEDIS® Cancer Screening

Breast Screening

Breast Screening

Percentage of women age 40-69 who had a mammogram to screen for breast cancer

Arise Health Plan: 73.63%
 
 
National Average: TBD
Cervical Screening

Cervical Screening

Percentage of women age 21-64 who received one or more Pap tests to screen for cervical cancer

Arise Health Plan: 72.26%
 
 
National Average: TBD
Colorectal Screening

Colorectal Screening

Percentage of members age 50-75 who had appropriate screening for colorectal cancer

Arise Health Plan: 68.61%
 
 
National Average: TBD

2015 HEDIS® Cardiac Care

High Blood Pressure

High Blood Pressure

Percentage of members diagnosed with high blood pressure who now have a controlled level

Arise Health Plan: 71.19%
 
 
National Average: TBD

2015 HEDIS® Child & Adolescent Care

Babies

Babies

Percentage of babies who received 6 or more visits in the 1st 15 months of life

Arise Health Plan: 70.71%
 
 
National Average: TBD
Children

Children

Percentage of children who received well child visits in the 3rd, 4th, 5th, & 6th years of life

Arise Health Plan: 83.6%
 
 
National Average: TBD
Adolescents

Adolescents

Percentage of adolescents who received a well visit

Arise Health Plan: 44.64%
 
 
National Average: TBD
Upper Respiratory

Upper Respiratory

Appropriate treatment for children with upper respiratory infection

Arise Health Plan: 96.03%
 
 
National Average: TBD
Pharyngitis

Pharyngitis

Appropriate testing for children with pharyngitis

Arise Health Plan: 57.33%
 
 
National Average: TBD
ADHD

ADHD

Percentage of members age 6-12 newly diagnosed with ADHD who had a follow up visit within 30 days

Arise Health Plan: 27.78%
 
 
National Average: TBD
Weight Assessment

Weight Assessment

Percentage of members age 3-17 who had their BMI percentile measured during a visit

Arise Health Plan: 75.67%
 
 
National Average: TBD
Nutrition

Nutrition

Percentage of members age 3-17 who received counseling for nutrition

Arise Health Plan: 72.02%
 
 
National Average: TBD
Physical Activity

Physical Activity

Percentage of members age 3-17 who received counseling for physical activity

Arise Health Plan: 58.64%
 
 
National Average: TBD

2015 HEDIS® Childhood Immunizations

DTaP

DTaP

Dtap (diphtheria, tetanus and acellular pertussis) vaccine

Arise Health Plan: 89.84%
 
 
National Average: TBD
Hepatitis B

Hepatitis B

Hepatitis B vaccine

Arise Health Plan: 89.84%
 
 
National Average: TBD
H Influenza

H Influenza

H influenza type B vaccine

Arise Health Plan: 92.19%
 
 
National Average: TBD
MMR

MMR

Measles, mumps and rubella (MMR) vaccine

Arise Health Plan: 90.62%
 
 
National Average: TBD
Polio

Polio

Polio vaccine

Arise Health Plan: 91.41%
 
 
National Average: TBD
Chicken Pox

Chicken Pox

Chicken pox vaccine

Arise Health Plan: 87.5%
 
 
National Average: TBD
Pneumococcal

Pneumococcal

Pneumococcal conjugate vaccine

Arise Health Plan: 89.84%
 
 
National Average: TBD
Rotovirus

Rotovirus

Rotovirus vaccine

Arise Health Plan: 92.97%
 
 
National Average: TBD
Influenza A

Influenza A

Influenza A vaccine

Arise Health Plan: 68.75%
 
 
National Average: TBD
Hepatitis A

Hepatitis A

Hepatitis A vaccine

Arise Health Plan: 85.94%
 
 
National Average: TBD

2015 HEDIS® Adolescent Immunizations

Meningococcal

Meningococcal

Percentage of adolescents 13 years of age who had one dose of meningococcal vaccine by their 13th birthday.

Arise Health Plan: 70.81%
 
 
National Average: TBD
Tdap/Td

Tdap/Td

Percentage of adolescents 13 years of age who had one tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap) or one tetanus, diphtheria toxoids vaccine (Td) by their 13th birthday.

Arise Health Plan: 90.68%
 
 
National Average: TBD

2015 HEDIS® Diabetes Care

HbA1c Screening

HbA1c Screening

Percentage of diabetic members who had a HbA1c test

Arise Health Plan: 95.04%
 
 
National Average: TBD
HbA1c (above 9%)

HbA1c (above 9%)

Percentage of diabetic members whose HbA1c result is greater than 9.0% - lower rate is better

Arise Health Plan: 49.88%
 
 
National Average: TBD
HgA1c (below 8%)

HgA1c (below 8%)

Percentage of diabetic members whose HbA1c result is less than 8.0%

Arise Health Plan: 42.55%
 
 
National Average: TBD
HgA1c (below 7%)

HgA1c (below 7%)

Percentage of diabetic members whose HbA1c result is less than 7.0%

Arise Health Plan: 23.97%
 
 
National Average: TBD
Kidney Monitoring

Kidney Monitoring

Percentage of diabetic members screened for kidney disease

Arise Health Plan: 87.94%
 
 
National Average: TBD
Eye Exam

Eye Exam

Percentage of diabetic members received an eye exam for retinal disease

Arise Health Plan: 63.59%
 
 
National Average: TBD
BP (below 140/90)

BP (below 140/90)

Percentage of diabetic members with a blood pressure <140/90

Arise Health Plan: 72.34%
 
 
National Average: TBD

2015 HEDIS® Other Types of Care

Prenatal Care

Prenatal Care

Percentage of pregnant women who received a prenatal care visit within the first trimester of their pregnancy

Arise Health Plan: 81.46%
 
 
National Average: TBD
Postpartum Care

Postpartum Care

Percentage of women who delivered a baby had a timely postpartum visit

Arise Health Plan: 90.73%
 
 
National Average: TBD
Adult BMI

Adult BMI

Percentage of members age 18-74 who had their BMI measured during a practitioner visit

Arise Health Plan: 83.7%
 
 
National Average: TBD
Imaging Studies

Imaging Studies

Use of imaging for low back pain - higher is better

Arise Health Plan: 82.7%
 
 
National Average: TBD
Antibiotic Avoidance

Antibiotic Avoidance

Avoidance of antibiotic treatment in the adults with acute bronchitis

Arise Health Plan: 30.71%
 
 
National Average: TBD
Spirometry

Spirometry

Use of spirometry testing in the assessment and diagnosis of COPD

Arise Health Plan: 42.86%
 
 
National Average: TBD
Asthma - 19-50 years

Asthma - 19-50 years

Use of appropriate medications for people with asthma - age 19-50 years

Arise Health Plan: 68%
 
 
National Average: TBD

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

The purpose of HEDIS and CAHPS is to identify areas of improvement in the quality of services provided for our members. Our Quality Team works tirelessly to increase the quality of services both internal to our organization and external with our provider partners. Here are a few projects that we’ve been working on to help improve the experience for you, our member.

Focus on Access to Care

A growing number of health plans offer tailored, or “narrow,” networks. When designed appropriately, this can be good: it allows health plans to increase the quality of each option they provide and to focus on patient experience and access to care. Our Quality Team works closely with our provider partners to provide a more comprehensive assessment of plan networks and focus on specialty areas that are either high volume (e.g., obstetrics/gynecology) or high impact (e.g., oncology). The intent is to evaluate whether health plans have enough in-network hospitals and doctors available to members so that all services will be accessible without an unreasonable delay.

More Accurate Information for Members

Consumers rely on the information they find in physician and provider directories to make decisions about which plan to enroll in and where to seek care. Inaccuracies in online or print directories can interrupt or delay care. Our Quality Team works with our provider partners to assess the accuracy of their directories; for example, whether providers have an active network contract or whether physicians are accepting new patients. The more accurate the information available, the easier it is for our members to navigate their health care experience.

Educating Members of Their Rights

Appropriate and timely coverage decisions are critical to ensure that patients receive the right care at the right time. Through member outreach and analysis, we’ve identified an issue where members did not know how to file an appeal for coverage of care—or if they could file an appeal. The Quality Team has been focusing on outreach and education materials that will ensure that members are notified of their appeal rights, their right to timely decisions about coverage of care, drugs, and services, and that members are provided with accurate reasons for a denial.

Provider Outreach

The Quality Team gathers large amounts of data through the course of HEDIS and CAHPS, which can be used to not only improve the performance of the health plan, but also improve the performance of the providers in our network. It is the Quality Team’s job to analyze this data and create action plans on how to address problem areas that have been identified. The Quality Team will then work with Provider Relations to help educate provider groups on areas where they could be doing a better job in order to make for a better experience for the member. This is particularly true with HEDIS because our data can show specifically which provider groups are struggling in specific measures. The Quality Team’s outreach enhances the overall experience and quality of care for our members both on the health plan side and the practitioner side.

The Quality Team also collaborates with our provider partners on a number of population health and public health initiatives to improve the overall health and well-being of our members. These projects include the Wisconsin Chronic Disease Quality Improvement Project, lead by the UW Population Health Institute, involvement with the Wisconsin Immunization Registry, and data-sharing projects with our provider partners to develop faster and higher quality care.