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Quality

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Quality
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GHC-SCW is Quality Driven

Group Health Cooperative of South Central Wisconsin is continuously working to provide quality care to our members. We focus our Quality Improvement work on a few things:

  • Quality and safety of clinical care of medical and behavioral health care
  • Quality of service and the member experience
  • Population health management

What is the National Committee for Quality Assurance (NCQA)? 

NCQA is a non-profit organization dedicated to improving health care quality. Health plans that seek Accreditation from NCQA face a rigorous set of standards & guidelines that must be adhered to and are evaluated on their performance or how well a health plan manages quality throughout every part of its delivery system. Accredited health plans proudly display NCQA’s seal of Accreditation, a widely recognized symbol of overall quality.

Seal displaying NCQA Health Plan Accredited with 4.5 out of 5 Stars

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How do we earn NCQA Health Plan Accreditation?

Every three years, GHC-SCW must provide NCQA with documentation demonstrating our performance on the standards to renew our Accreditation and a defined set of our internal case management, utilization management, appeals and credentialing files for compliance with regulatory requirements.

Each year, Accredited health plans are evaluated by NCQA to determine the overall rating of the plan. This review includes:

  • Healthcare Effectiveness Data and Information Set (HEDIS®): a set of standardized clinical quality performance measures
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS®): a group of surveys that ask patients questions about their experience with the health plan.
  • Accreditation Standards: Health plans are evaluated on their performance of the standards and how well the health plan manages quality throughout every part of its delivery system.

Seal Displaying NCQA HEDIS Commercial Compliance Audit for 2022 Seal Displaying NCQA HEDIS Exchange Compliance Audit for 2022 Seal Displaying NCQA HEDIS Medicaid Compliance Audit for 2022

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What does this mean for you?

NCQA’s health plan ratings help you see the quality of health plans on the market. This helps you make informed decisions on the true value of your plan, not only based on cost.

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NCQA Health Equity Accreditation

NCQA Health Equity Accreditation recognizes organizations that lead the market in providing culturally and linguistically sensitive services, and work to reduce health care disparities. This accreditation focuses on the foundation of health equity work: building an internal culture that supports the organization’s external health equity work, collecting data that help the organization create and offer language services and provider networks mindful of individuals’ cultural and linguistic needs, and identifying opportunities to reduce health inequities and improve care.

Seal Displaying NCQA Health Equity Accredited

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Quality Management Plan

GHC-SCW develops a Quality Improvement Work Plan that guides each year’ efforts to continuously improve the quality and safety of medical and behavioral health care and the quality of services provided to our members. A customized quality improvement system makes certain we’re achieving our goals and objectives.  We strive to:

  • Actively support GHC-SCW’s mission, vision, values’ and strategic pillar initiatives.
  • Identify clinical, service, safety and/or behavioral health issues or needs important to our membership as opportunities for improvement.
  • Create interventions or activities to address the needs or issues identified.

Quality Improvement Program Annual Report

Health Outreach

GHC-SCW is committed to helping keep you healthy. That includes helping you understand how to manage your chronic disease. We have programs and services available for many conditions. Through the programs, we’ll provide you with resources that can improve your health and well-being.

To support you, GHC-SCW and your care team may send you periodic mailings or secure GHCMyChart messages to remind you of tests or services that you are due for. If you meet clinical criteria, we do not take any action to exclude you from services or programs that you may benefit from. You can opt-out by following the instructions in the message you received. ​​

Use the link to read our list of routine clinical and health plan outreach activities.