Culture of Quality Places Tufts Health Plan at Top of the NCQA Rankings

Tufts Health Plan was ranked the No. 1 private health insurance plan and No. 1 Medicaid insurance plan in the country in the National Committee for Quality Assurance (NCQA) Health Insurance Plan Rankings 2014-2015. Christie Fluery, senior manager of quality and accreditation programs notes, “It’s part of the culture here from the top down. Everyone is really focused on being a top-performing plan. ”

It is this culture of quality that focuses Tufts Health Plan on educating its members and listening to their needs. According to the quality team at Tufts Health Plan, by working with a coalition of New England plans to understand the NCQA measures, it has been able to develop strategies to get high scores across the board.

This focus on quality care has found its way into Tufts Health Plan’s relationship with its providers as well.

“In New England, you have a network of physicians who are very focused on quality of care,” says Patrice Fisher, senior manager for quality reporting. “We work with providers all the time to educate them on what the measures are and how they can capture the information. We want providers to focus on what is the best care for that individual and not just the numbers.”

The same consistency in quality of care is found in the experience of its members. Tufts Health Plan has been committed to creating consistent, quality care for all by creating a member experience team. By conducting focus groups, surveys and other types of intelligence gathering, Tufts Health Plan has been able to focus on ensuring that all members experience the best service and treatment.

“The member experience team was a big contributor to addressing the pain points for members,” says Wendy Jacobson, senior manager of market intelligence. “We specifically looked at our CAHPS results and did a lot of research to try and pinpoint target populations with more dissatisfied answers. We took this information and customized our initiatives to target populations that were appropriate.”

Across the board, ACHP members received high rankings with nine of the nation’s top 10 Medicare plans, six of the top 10 plans in the commercial rankings and three of the top 10 Medicaid plans. An additional 23 plans were among the top 5 commercial plan providers in their state.

More information is available here.