SummaCare’s Quality Management Strategy

Program Description

SummaCare provides a comprehensive, community-focused health plan that maximizes service and choice to our providers, members and employers. We are committed to a thorough and effective Quality Management Program that follows the principles of Continuous Quality Improvement to improve the care and services members receive.

Major goals and objectives of the program include:

• Promoting and building quality into the structure and processes of our organization
• Monitoring and working to improve outcomes
• Enhancing the customer experience and promoting preventive health and wellness through targeted interventions 
• Promptly identifying opportunities for improvement with actions for resolution

To remind and encourage members to get their preventive screenings for chronic conditions such as diabetes and cardiovascular disease, we continue to mail our annual preventive health and care opportunity letters. These letters help identify recommended services for you and your family.  The care opportunity letter is only 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 letters are followed-up by a reminder phone call later in the year for members with continued care opportunities.  We are also piloting other forms of outreach to members to determine additional effective ways to hlep 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.