Quality Matters

It is important to us that you receive quality health care and customer service.

Quality improvement strategy
We are working hard to improve the service, quality and safety of health care. One way we do this is by measuring how well we and others are doing.

We work with groups of doctors and other health professionals to make health care better.

Our clinical activities and programs are based on proven guidelines.

We also give you and your doctor information and tools that may help you make decisions.

Program goals
We aim to:

  • Meet our members’ health care needs.
  • Measure, monitor and improve the clinical care and quality of service our members get.
  • Institute company‐wide initiatives to improve the safety of our members and communities.
  • Make sure we obey all the rules, whether they come from plan employers, federal and state regulators or accrediting groups.

Program scope
We work to make your health care better by:

  • Developing policies and procedures that reflect current standards of clinical practice.
  • Reviewing preventive and behavioral health services, and how care is coordinated.
  • Addressing racial and ethnic differences in health care.
  • Monitoring the effectiveness of our programs.
  • Studying the accessibility and availability of our network providers.
  • Performing credentialing and recredentialing activities.
  • Assessing member and provider satisfaction.

Program outcomes
Each year we check to see how close we are to meeting our goals. Here's what we did last year:

  • We collected data on a set of clinical measures called the Healthcare Effectiveness Data and Information Set (HEDIS®*), as applicable. We shared the results with the National Committee for Quality Assurance (NCQA) Quality Compass®**. The NCQA makes the results public. Each year, we use the results to set new goals and improve selected measures. As a result, performance has improved on many measures.
  • We asked members how satisfied they are with Aetna Better Health of Florida. We improved in rating of health care, personal doctor and specialist, and how well doctors communicate. We met the cultural and language needs of our members.
  • We surveyed members in the Disease Management Program. They told us they were satisfied with the program overall. The program helped them understand and improve their health. It also helped them follow their treatment plans, and reach their health goals.
  • We also:
    • Continued with our patient safety program.
    • Improved access to providers.
    • Improved communication between members’ Primary Care and Behavioral Health Physicians.

Accreditation
We take our accreditation by the NCQA seriously. It's how we show our commitment to improving your quality of care, access to care and member satisfaction.
Get more information about our NCQA accreditations.

* HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
** Quality Compass is a registered trademark of NCQA.

Our goal is to correct any problems our members may have. If you have a problem, call Member Services.

Medicaid Member Services at 1-800-441-5501
Comprehensive Long Term Care Member Services at 1-844-645-7371
Florida Healthy Kids Member Services at 1-844-528-5815

A complaint is when you are not happy with a service you received. An example may be a long wait time at your doctor’s office. Another example may be your overall satisfaction with the health care services you received.

Members or authorized representatives such as a friend, family member or doctor.

You can file a complaint by calling or writing. A complaint may be filed any time you are unhappy with your health care services.

If you are not happy with the outcome of your complaint, you may file a grievance.