Caring Starts with Emphasis on Quality
Care Wisconsin is committed to improving our processes to help our members achieve their health outcomes and long term care goals. We strive to not only meet quality and regulatory guidelines but to exceed them.
Quality reviews are a rigorous but welcome process that help us with continuous improvement. These annual quality reviews also provide members and our Wisconsin community with transparency and accountability. These are values we hold dear in all aspects of our business – from hiring and developing staff to the relationships we build with members and providers.
CMS (Medicare) Star Ratings and Metastar Ratings
For the plan year 2019, Care Wisconsin received 5 out of 5 stars in the Medicare Star Ratings for our health plan. (In 2018, we scored 4.5 out of 5 stars–read the 2018 memo). This 5-star rating has earned us a spot on U.S. New and Word report’s list of Best Insurance Companies for Medicare Advantage. To learn more about how we made that list, read more about plan quality criteria.
Each year, MetaStar, the External Quality Review Organization under contract with the Wisconsin Department of Health Services (DHS) provides an independent evaluation of compliance with federal Medicaid managed care regulations and DHS contract requirements for our organization.
Compliance Audits and Programs
Healthcare Effectiveness Data and Information Set (HEDIS) is the measurement tool used by the nation’s health plans to evaluate their performance in terms of clinical quality and customer service.
The National Committee for Quality Assurance (NCQA) accredits and certifies a wide range of health care organizations and manages the evolution of HEDIS®, the performance measurement tool used by more than 90 percent of the nation’s health plans. Consumers can easily access organizations’ NCQA statuses and other information on health care quality on NCQA’s website or by calling NCQA Customer Support at (888) 275-7585
Grievances, Appeals, and Member Rights
Care Wisconsin protects member rights and has a dedicated team that addresses the concerns of members if they or their representatives are ever dissatisfied with decisions or services.
Our well-defined process that meets all Wisconsin Department of Health Services (DHS) requirements. We encourage members to exercise their rights! Visit our Grievances and Appeals page to learn more about the process and contact information.