Quality Management

SummaCare's Mission is to work with providers, members and employers to provide a comprehensive community-focused health plan that maximizes service and choice. We are committed to a thorough and effective Quality Management Program that follows the principles of Continuous Quality Improvement. Each year we strive to improve the care and services that our members receive.

The major goals and objectives of our Quality Management Program include promoting and building quality into the structure and processes of our ogranization and monitoring and working to improve outcomes. In 2011 the Quality Improvement Program continued to focus on enhancing the customer experience and promoting preventative health and wellness through targeted interventions.

Ensuring prompt identification of opportunities for improvement with actions for resolution is a major goal for SummaCare. To assist members in obtaining preventive screenings and optimal care for chronic conditions such as diabetes and cardiovascular disease, we continued our annual Preventive Health Letter that identifies recommended services for you and your family and the care oportunity letter. The care opportunity letter is sent to members if we have not received claims by mid-year for the recommended cancer screenings, blood pressure checks and other tests or services. The care opportunity letters are intended to remind and encourage our members to contact their physicians to obtain the care they need. The letters are followed-up by a reminder phone call later in the year for members with continued care opporunities. We are also piloting other forms of outreach to members to determine additional effective ways to help members get the care they need.

For more information on our Quality Management Program, visit the member section on the website. If you would like a summary of the annual program evaluation, call (330) 996-8754.