Quality Matters

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

Our 2018 Quality Results

We work hard to make sure you get the best health care and service. Each year we look at how well we are doing and set goals. If we don’t reach our goals, we make a plan to help us improve.

We use HEDIS® (Healthcare Effectiveness, Data and Information Set) to measure if our members are getting good care.  HEDIS®  is used across the country to compare health plans.  Here are some of the 2018 calendar year HEDIS results:

Areas where we met our goals:

  • Well visits in the first 15 months of life
  • Well visits for 3 to 6 year-olds
  • Adolescent well care
  • Childhood weight and nutritional counseling
  • Childhood immunizations
  • Lead screening
  • Prenatal and postpartum care
  • Management of chronic conditions, such as high blood pressure, diabetes, and asthma
  • Breast and cervical cancer screening

Areas where we did not meet our goals:

  • Follow-up after hospitalization for mental illness
  • Eye exams for members with diabetes
  • Follow-up care for children prescribed ADHD medication

We also conduct a member satisfaction survey each year. The survey is called CAHPS®. The results from the survey help us:

  • Get feedback from members
  • Learn more about our members’ needs
  • Compare our service to other health care plans
  • Find ways to improve

Here are some of the CAHPS survey results from the survey completed in 2018.  We met ALL goals on the child survey.  On the adult survey: 

Areas where we met our goals:

  • Rating of all health care
  • Rating of specialist seen most often
  • Rating of personal doctor
  • How well doctors communicate

Areas where we did not meet our goals:

  • Getting needed care
  • Getting needed care quickly
  • Customer Service
  • Rating of health plan

More information can be found on our website or by contacting Member Services.  We will continue to work hard to make sure you get the best health care and service.

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.