More Than a Health Plan: CDPHP Tops NCQA Ratings

Only 11 commercial plans in the U.S. have received a 5 out of 5 rating from the National Committee for Quality Assurance 2015-2016 Health Insurance Plan Ratings. Of these, two are Capital District Physicians’ Health Plan (CDPHP) commercial plans, and six CDPHP commercial, Medicaid and Medicare plans are top-rated in New York.

According to Vice President of Health Care Quality Renee Golderman, CDPHP’s driving force lies in its company-wide commitment to quality: “CDPHP embodies quality culture as a plan.”

CDPHP’s culture of quality is embedded in its daily procedures and practices. All CDPHP employees are passionate about quality—it permeates CDPHP’s environment and focuses its mission.

Renee added, “Customer service is a core tenet of who we are as an organization and speaks to our quality.” CDPHP divides its quality efforts into two separate member-engagement outreach programs: its focus on population health and its enhanced primary care model.

CDPHP is invested in forging community connections that foster health across populations. By working with primary caregivers, the plan identifies members who are not responding to outreach and engages with them on their own terms.

CDPHP’s Enhanced Primary Care (EPC) initiative is a patient-centered medical home model that rewards doctors for spending increasing amounts of time with their sickest patients. The program strives to create and sustain long-term relationships between patients and primary care providers, particularly through measures such as telehealth and preventive care. The initiative moves beyond the traditional fee-for-service model and organizes reimbursement around quality. In 2014, CDPHP saw $20.7 million in cost-savings due to its EPC program; EPC providers also received around $12.8 million more in reimbursements and bonuses.

The EPC program strengthens CDPHP’s commitment to population health and its integration in the communities it serves. CDPHP employees live and work with their members. CDPHP is local—it is personally invested, driven and dedicated to improving member health. Being more than a health plan helps CDPHP enact health care’s fundamental objective: providing holistic, high-quality care at lower costs.


Read more about the NCQA ratings and how ACHP plans performed.


-Zoya Haroon