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Quality Highlights

Quality Matters at UCare

Our Quality and Population Health Program supports our mission to improve our members' health by addressing health equity and health care disparities through innovative services and community partnerships. Every year, our Quality Program is evaluated to make sure it is effective and meaningful, and that is meets regulatory standards and guidelines. Results from our annual evaluation help us develop, prioritize and track our progress toward our quality plan goals.

Thanks to strong collaboration with our providers and community partners, UCare delivers measurably high-quality care to every one of our members. Quality monitoring and program initiatives continue to demonstrate positive outcomes.

2021 Medicare Star Ratings*

The Medicare Program rates all health and prescription drug plans each year, based on a plan’s quality and performance. Medicare Star Ratings help you know how good a job our plan is doing. The scale ranges from one to five stars, with five being the best and one being the worst. You can use these Star Ratings to compare our plan’s performance to other plans. Star Ratings are based on five heath service categories:

  1. Keeping members healthy through preventive screenings, vaccines, and other check-ups
  2. Managing chronic (long-term) conditions
  3. Member satisfaction with their health plan, drug plan, and provider
  4. Operational performance
  5. How well plans handle customer requests

The 2021 Star Ratings were released in October 2020 and apply to the 2021 Medicare Advantage plan year. UCare received the following Overall Star Rating for our Medicare programs:

UCare Medicare – 4.5 Stars
Minnesota Senior Health Options – 4 Stars
UCare Connect+Medicare – 4.5 Stars

*Star Ratings are based on 5 Stars. Star Ratings are assessed each year and may change from one year to the next.

Why do Star Ratings Matter?

Medicare rewards plans that achieve four and five Star Ratings with a bonus payment that can only be used to reinvest back into plan benefits and programs. This means, the better UCare does to support you and your health care needs, the better our benefits for you can be in the future.

How can you help?

  • Schedule an Annual Wellness visit every year
  • Receive your screenings and preventive care, including your flu shot and vaccines
  • Complete and return all member surveys
  • Discuss and monitor your physical and mental health with your doctor
  • Work with your doctor or pharmacy to stay up-to-date on your medications

2020 Health Insurance Exchange Quality Ratings System

The Centers for Medicare and Medicaid Services (CMS) administers the Quality Ratings System (QRS) to measure the overall quality of care and services provided by Quality Health Plans (QHPs) to its members. The scale ranges from one to five stars, with five being a high performing health plan and one being a low performing health plan. You can use these Star Ratings to compare our plan’s performance to other plans.

A plan's overall rating is based on three categories, each with its own star rating:

  • Member experience: Based on surveys of member satisfaction with:
    • Their health care and doctors
    • Ease of getting appointments and services
  • Medical care: Based on how well the plan's network providers manage member health care, including:
    • Providing regular screenings, vaccines, and other basic health services
    • Monitoring some conditions
  • Plan administration: Based on how well the plan is run, including:
    • Customer service
    • Access to needed information
    • Network providers ordering appropriate tests and treatment

Due to coronavirus disease 2019 (COVID-19) emergency, ratings for 2021 plan year (2020 Star Ratings) are based on data provided in 2019. UCare received the following Overall Start Rating for our programs:

UCare Individual & Family Plans - 3 Stars


NCQA Accredited

NCQA Health Plan Accreditation

In 2020, UCare’s full line of Medicare, Medicaid and Individual & Family health plans earned Health Plan Accreditation from the National Committee for Quality Assurance (NCQA). UCare has maintained a highly rated accreditation status since 2014 for UCare Medicare and Individual & Family Plans, and the expansion of accreditation of all UCare products attests to UCare’s commitment to the highest standards of quality.


Learn More About Our Quality Programs

The Quality Management Department annually reviews the quality work from the previous year, analyzes the progress toward our goals, and identifies new focus areas and goals for the upcoming year.

Quality Management Program Description 2021 

Quality Management Program Evaluation 2020 

Quality Management Program Work Plan 2021 


Member Satisfaction

The Centers for Medicare & Medicaid Services (CMS) and Department of Human Services (DHS) gauges member satisfaction of Medicare Advantage and Medicaid plans through an annual survey called the CAHPS survey (Consumer Assessment of Healthcare Providers and Systems). CMS also administers a member experience survey to marketplace health plans called the Qualified Health Plan Survey (QHP). The CAHPS/QHP survey helps health plans identify opportunities to improve quality and services, and helps CMS and DHS monitor the quality and performance of these plans.

UCare scored above the national average on several 2020 measures and have identified focus areas that are highlighted below.


Measure Product 2018 Rate 2019 Rate 2020 Rate National Average Interventions
Customer Service UCare Medicare 3.75 3.76 3.70 3.71
  • Increased focus on communication and customer service delivery excellence to drive positive interactions with our members and drive member trust.
  • Continue to work with CS representatives on motivational interviewing techniques by teaching them how to roll with resistance and remove themselves from the outcome, while still being able to connect with the individuals to understand their wants and needs.
UCare's MSHO 3.63 3.67 3.54 3.71
UCare Connect + Medicare 3.69 3.72 3.53 3.71
Individual & Family Plan 3.30 2.82 2.86 2.80
Product 2018 Rate 2019 Rate 2020 Rate MN Average
Families & Children 62% 87.0% 86.0% 86.6%
MinnesotaCare 63% 85.0% 88.6% 83.3%
MSC+ 47% 88.6% 88.8% 89.6%
UCare Connect 68% 88.4% 85.9% 87.8%

Measure Product 2018 Rate 2019 Rate 2020 Rate National Average Interventions
Rating of Plan UCare Medicare 8.90 8.94 8.93 8.73
  • Continue member outreach strategies including, but not limited to: IVR calls, telephonic outreach after interim surveys, member mailings (e.g. survey and formulary changes), etc.
  • UCare will continue to partner with culturally competent community service providers to improve member health, healthcare and health insurance literacy.
UCare's MSHO 8.60 8.87 8.81 8.73
UCare Connect + Medicare 8.60 8.72 8.69 8.73
Individual & Family Plan 6.90 6.17 6.24 7.05
Product 2018 Rate 2019 Rate 2020 Rate MN Average
Families & Children 64% 58.8% 61.6% 57.6%
MinnesotaCare 55% 57.1% 55.8% 51.3%
MSC+ 53% 59.0% 61.3% 62.1%
UCare Connect 60% 62.8% 59.0% 59.1%

Measure Product 2018 Rate 2019 Rate 2020 Rate National Average Interventions
Rating of Drug Plan UCare Medicare 8.40 8.41 8.50 8.61
  • Continued work with analyzing the formularies and prescription drugs applicable to these members. Review feedback from the interim CAHPS surveys and appeals and grievance data to better understand the needs of these populations.
  • Improved member communications of the impact of formulary changes in a clear and concise manner.
UCare's MSHO 8.50 8.90 8.90 8.61
UCare Connect + Medicare 8.50 8.69 8.63 8.61

Measure Product 2018 Rate 2019 Rate 2020 Rate National Average Interventions
Getting Needed Care UCare Medicare 3.64 3.59 3.47 3.51
  • Annually conduct network adequacy assessments to assess the availability of providers/practitioners and their ability to provide needed care and getting care quickly from a member standpoint.
  • Identify providers to contract with UCare to improve greater access and convenience of care for members.
  • Expand and educate members on various levels of services to provide quick and timely access to care. These services may include: virtual care, Telehealth, etc.
UCare's MSHO 3.42 3.38 3.15 3.51
UCare Connect + Medicare 3.46 3.53 3.22 3.51
Individual & Family Plan 3.34 2.89 3.17 2.98
Product 2018 Rate 2019 Rate 2020 Rate MN Average
Families & Children 55% 83.0% 79.4% 81.3%
MinnesotaCare 57% 82.4% 81.1% 83.0%
MSC+ 51% 54.1% 82.0% 84.7%
UCare Connect 53% 82.3% 82.7% 83.6%

* CMS stopped the submission of official CAHPS results due to COVID-19, so a 2020 National Average was not calculated.

UCare's Quality Improvement Initiatives

UCare's Quality Improvement Initiatives

The Quality and Population Health Program is committed to innovation, affordability, professional competence and continuous learning, teamwork and collaboration. The program places an emphasis on addressing health equity and health care disparities of our members. Further, quality of care and services are optimized and continuously improved while maintaining cost-effective utilization of health care resources. This is accomplished by systematic monitoring and evaluation of provided services and by actively pursuing opportunities for improvement. The table below provides some examples of projects that both monitor services and pursue improvements.


Opioid - New Users

Product Measure Goal Interventions Lessons Learned Member Resources

- PMAP

- MnCare

- IFP

- MSHO

- UMP

- Connect

- Connect + Medicare

Members who are newly prescribed opioids Decrease the number of members being prescribed opioids

- Provider education

- Provider & pharmacy alignment

- Provider toolkit & webinar series

- Consistent messaging for community outreach: opioid brochure

- Tailor interventions to increase member engagement

- Work collaboratively with prescribers & pharmacy and/or pharmacists on intervention strategies

- Create a member toolkit

- Provide webinars for care coordinators and pharmacists

Taking Action on Opioid Epidemic

Priority Plan on Opioid Use

Opioid Education Brochure

Free Drug Disposal Pouch

Products  
IFP Individual & Family Plans
MnCare MinnesotaCare
MSC+ Minnesota Senior Care Plus
MSHO Minnesota Senior Health Options
PMAP Prepaid Medical Assistance Program
Connect UCare Connect (Special Needs BasicCare)
Connect+Medicare UCare Connect + Medicare (Special Needs BasicCare)
I-SNP Institutional Special Needs Program
UMP UCare Medicare Plans
EssentiaCare EssentiaCare (Medicare)
MH FV/NM UCare Medicare with M Health Fairview and North Memorial

Product Rate of New Chronic Users
  2016 (Baseline) 2017 2018 2019
Connect 9.48% 9.71% 9.76% 6.9%
Connect + Medicare - 34.88% 24.43% 16.3%
EssentiaCare 22.92% 10.47% 6.84% 15.8%
UMP 8.73% 8.37% 7.95% 11.1%
MnCare 3.39% 5.95% 2.95% 2.5%
MSC+ 7.69% 7.37% 9.66% 4.8%
MSHO 16.15% 17.83% 17.23% 13.6%
PMAP 3.22% 3.44% 4.11% 2.9%
IFP 7.27% 11.21% 7.95% 17.9%

Improving Dental Utilization and Access

UCare continues to work on improving dental utilization for our UCare members.

If you need assistance in finding or locating a dental provider, please call UCare Dental Connection at 651-768-1415 or 1-855-648-1415 (toll free), or TTY: 711, from 7 am – 7 pm, Monday – Friday. Additional Customer Service hours and days of operation, and phone numbers are here.


Product Measure Goal Interventions Lessons Learned Member Resources

- UCare Connect

- UCare Connect + Medicare

- UCare MnCare

- UCare MSC+

- UCare MSHO

- UCare PMAP

Annual Dental utilization rates

Increase dental utilization to improve dental rates for our members

- Care Coordination training & education

- Telephonic outreach to members

- Education to both members & providers on using UCare’s Dental connection to schedule and coordinate dental needs

- Provider education on referring members for dental exams

- Medicaid Dental Service Grid

- Collaborated with MN Direct Care and Treatment Dental Clinics and created a referral decision tree.

- Lifting Prior Authorization requirements for additional cleanings

- Dental Provider Toolkit

- Health Promotion dental kits for adults and children

- Annual Dental Visit $25 incentive

- UCare Dental Connection helps our members manage their dental care with one simple phone call.

- UCare Dental Connection helps our members manage their dental care with one simple phone call.


Current Performance Improvement Projects:

Commencing in 2021 and continuing through 2023, UCare is working together with a collaborative group of Minnesota Managed Care Organizations (MCO) and the Department of Human Services (DHS) to improve the quality of care for Minnesota enrollees.


Healthy Start for Mothers and their Children

This Performance Improvement Project (PIP) is intended to promote a “Healthy Start” for Minnesota children in the PMAP and MnCare populations by focusing on and improving services provided to pregnant members, infants, and children particularly in areas exhibiting the most significant racial and ethnic disparities.

Product HEDIS Measures Goal Interventions

- PMAP

- MnCare

Timeliness of Prenatal and Postpartum Care

Well Child Visits (Ages 0-15 Months – 6 or more visits)

Well Child Visits (Ages 16-30 months – 2 or more visits)

Childhood Immunization Status (Combo 10)

Improve timeliness of prenatal care & postpartum care

Increase well-child visits rates

Decrease health  disparities.

- Organizational redesign of Prenatal and Postpartum Case Management

- Telephonic outreach to members

- Member incentives

- MOMs Program

- SEATS Program

- Community-based Engagement

- Provide education and Resources

- Provider Partnerships

- Benefit Assessment

- Tool to connect members to social services & community resources

- Food & nutritional resources

- Healthy Savings Program


Diabetes

This Performance Improvement Project (PIP) is aimed at improving Comprehensive Diabetes Care and services for Seniors and our Special Needs members with the focus on health care disparities. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health.

Product HEDIS Measures Goal Interventions

- MSHO

- Connect & Connect+Medicare

- MSC+

Comprehensive Diabetes Care:

- A1c Testing

- Nephropathy testing

- Eye exam

Improve the Comprehensive Diabetes Care and services for Seniors and SNBC member with the focus on disparities.

- Community outreach and partnership

- Disease Management Program

- Member incentives

- Tool to connect members to social services & community resources

- Food & nutritional resources

- Healthy Savings Program

- Provider Partnerships

- Use analytics & predictive modeling to assess the impact of member preferences for communication & determine intervention effectiveness 

- Provide in-home testing kits for diabetic screenings- Provide in-home testing kits for diabetic screenings

- Telephonic outreach