CareMore Health Plan: Your Prescription for Quality Health Care
CareMore Health Plan is a new model of care and is your personal prescription for quality health care. It’s just what the doctor ordered! CareMore is different than traditional health insurance plans. We combine wellness programs and medical management programs to enhance our members lives as they age.
We continue to develop innovative disease management programs just for you to meet your needs and assist you with the challenges you may be facing. We take the time to measure the effectiveness and value of our programs and to make sure we are doing all that we can to help you Live More, with CareMore. It’s our quality connection, the CareMore way of providing quality health care and ensuring optimal member outcomes. It is our hope to provide members with helpful information and answers to questions they may have about our Quality and Utilization Programs.
Frequently Asked Questions: Quality and Utilization Management Programs
• What are some examples of the Quality and Performance Indicators that CareMore measures, and why do you measure them?
Access and Availability to Healthcare - To make sure our provider network is adequate to meet our member needs; To add physicians as needed and increase hours of operation to meet demand;
Site Visits and Office Reviews - To validate that provider offices are safe, convenient and appealing; To identify potential areas where updates and improvements may be needed;
Medical Record Reviews - To ensure complete and comprehensive medical record keeping practices; To ensure that abnormal lab results and consults are reviewed promptly for action;
• Are the CareMore physicians reviewed and monitored? All physicians new to CareMore must pass a Credentialing process. This is to ensure a competent provider network. On-going monitoring is also conducted to measure physician performance in areas such as Quality of Care, Preventive Care, Member Complaints and Member Satisfaction.
• Does CareMore conduct Member Satisfaction Surveys? CareMore does conduct surveys to determine our members’ level of satisfaction with the care and services they receive. If you receive a call or letter requesting your participation, please do so. We want to hear from you, so that we can adjust our processes to better serve you.
• Does CareMore review member complaints to see if there is a pattern? We take this process very seriously. We look at each inquiry on an individual basis, and adjust the course of action as needed for that member. We then look to see if this is a frequent issue or trend that may require a system change or solution. We then make that change to improve your health care experience.
• How does CareMore manage the utilization of health care services? CareMore uses a Utilization Management Program. This program is in place to assure the delivery of medically necessary and quality patient care through the appropriate utilization of healthcare resources.
• I’m confused. Doesn’t more medical care mean better care? That is a common misconception. More care can actually be harmful in some instances. That’s why we have a check and balance process in place called Utilization Management.
• What is a prior authorization or review guideline? CareMore has clinical practice guidelines or rules in place to ensure best practice. It may be necessary for services to be prior authorized or reviewed before care is given. This is to ensure your treatment plan is the best for you. It’s similar to a second opinion to and validates the recommended treatment. This is one case where it is worth the wait and we appreciate your patience while we complete this important function. This is our internal stamp of approval.
Download the CareMore Health Plan Utilization Management Form
• What do I do if I have a potential quality concern? We want to hear from you anytime but especially when you have a question or concern that needs our attention. Please contact your Member Services Department Representative at (888) 816-2790 for immediate assistance. Please don’t hesitate to call so we can work through this situation together.
We will continue to keep this site updated so that it is a helpful resource to you. If you have any questions or concerns, please do not hesitate to contact us. We look forward to hearing from you to maintain our quality connection!