SummaCare provides a high-quality, low-cost comprehensive, community-focused health plan that maximizes service with our integrated health system 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:
SummaCare reminds and encourages members to get their preventive screenings by mailing annual preventive health letters. For members with chronic conditions such as diabetes and heart disease, care opportunity letters are also sent, which provide important information about screening and care for specific conditions. These letters help identify recommended services for the member and their 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 by a reminder phone call later in the year for members with continued care opportunities. SummaCare continues to evaluate and improve our outreach to members and providers to determine additional effective ways to help members get the care they need.
SummaCare uses Healthcare Effectiveness and Data Information Set (HEDIS) to guide our member engagement in preventive health and condition management programs. We use Consumer Assessment of Healthcare Provider (CAHPS) to evaluate our member satisfaction with our network of providers. We have established value based agreements with providers in our network to ensure our members are receiving the highest quality care available.
SummaCare has been accredited by the National Committee for Quality Assurance (NCQA) since 2001. Click here to view our current accreditation status: https://www.summacare.com/about-us/quality-ratings
NCQA is an organization dedicated to improving health care quality, and the NCQA seal is a widely recognized symbol of quality. Organizations must first pass a rigorous, comprehensive review and must annually report on their performance. For consumers and employers, the seal is a reliable indicator that an organization is well-managed and delivers high quality care and service.Learn more about NCQA.
Agency for Healthcare Research and Quality Patient Safety Organizations
Comparing Providers using the Leapfrog Group
National Committee for Quality Assurance Accreditation (NCQA)
SummaCare’s goal is to offer the highest quality healthcare to our members. This is accomplished, in part, by building a provider network of physician and practitioner professionals who meet SummaCare’s standards.
Through the process of "credentialing," all new physicians and practitioners in the network are reviewed to assure their professional status is in compliance with our standards. After a physician or practitioner has been credentialed, his or her professional status is re-verified every three years in a process called "recredentialing."
SummaCare also credentials health delivery organizations such as hospitals, skilled nursing facilities and free-standing surgery centers.
View patient eligibility, benefits, claims status, and self-funded prior authorization lists, as well as review clinical edits and clarifications.