Jefferson Health Plans has a quality management program to make sure that our members receive safe and effective clinical care that is timely, and patient centered. Throughout the year, Jefferson Health Plans monitors the delivery of health care to members and annually evaluates the entire program to determine if goals were met and define goals for the year ahead.

2023 Accomplishments

CAHPS Survey Strength/Power (performance is above the average)

• Medicaid (Adult)
  • Rating of Health Care
  • Rating of Personal Doctor
  • Getting Care, Test or Treatment
• Medicaid (Child)

• • Rating of Health Care
  • Rating of Dental Care 
• CHIP

• • Treated with Courtesy and Respect (Customer Service)
  • Doctor explained things to the child (How Well Doctors Communicate)
  • Doctor showed respect (How Well Doctors Communicate)
• Medicare

• • Rating of Drug Plan
  • Rating of Specialist
  • Getting Information/Help (Customer Service)

HEDIS 2023 - Measurement Year 2022 – Improvement

• Medicaid (Adult and Child)
  • Oral Evaulation, Dental Services
  • Well Child Visits in the First 15 Months of Life (W30 15 months)
  • Developmental Screening
• CHIP
  • Well-Child Visits Ages 3-21
• Medicare

• • Diabetes Eye Exam
  • Colorectal Cancer Screening
  • Med Rec Post Discharge
  • Breast Cancer Screening

Quality Management Goals for 2024

• Improve health outcomes through greater access to quality care
• Improve HEDIS rates
• Improve member satisfaction with the plan and provider services
• Maintain National Committee for Quality Assurance (NCQA) accreditation
• Ensure member complaints and quality of care cases are opened and processed within specified timeframes
• Address members’ needs from a race, linguistic and ethnicity perspective
• Ensure contractual reports are received timely from delegated vendors
• Process all credentialing and re-credentialing files within regulatory timelines
• Continue reviewing prescription drug claims and monitoring opioid utilization to improve patient safety/cost effectiveness

For more information

For more details about our accomplishments, please call our Quality Management department at 215-991-4202.