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Quality Management Program Summary

Purpose

Wellmark’s Quality Management Program is committed to value-based health care by providing access to high-quality care, exceptional customer service, broad provider access, conducting a thorough oversight of program activities, and offering affordable health care and services. The Quality Management Program supports this commitment through:

  • Care Management Programs designed to support members with managing chronic medical conditions and diseases, ongoing health maintenance, and preventive services. 
  • Care Coordination that includes the use of health care services, continuity of care, and care coordination approaches across health settings to ensure members’ health care needs are met by the right provider, at the right time, and with the right care.
  • Provider Programs and Services that include provider satisfaction, education, access to care, quality outcomes, and member safety.
  • Oversight Groups that consist of internal and external health care professionals who assess and oversee the quality management program and ensure decisions align with the program goals.
  • Customer Service that’s focused on monitoring and improving Wellmark processes and operations to create a differentiated customer experience. This is done through measuring:
    • Effort: how easy is it to do business with Wellmark
    • Education: how well informed to our members feel about their health insurance benefits or services
    • Emotion: members’ overall experience and impression of Wellmark

Process

The Quality Management Program includes internal and external resources committed to identifying and developing actionable work plans that are focused on increasing member satisfaction and continuously improving quality. As part of our commitment to provide members with access to quality care and services, Wellmark follows a measured and ongoing process to improve the Quality Management Program, including:

  • Gathering and analyzing data and member feedback
  • Identifying improvement opportunities 
  • Implementing solutions and measuring the results

These improvement efforts are to ensure our members receive best-in-class quality care and services.

Outcomes

Each year, Wellmark assesses the Quality Management Program results and identifies areas of focus for the following year. Information from several sources, including feedback from health care providers and members, is used to measure our performance. Here are some results:

  • Wellmark exceeded targeted goals for members receiving care quickly, getting the necessary tests and treatments when needed, and for processing health claims quickly.
  • Wellmark received National Committee for Quality Assurance (NCQA) Health Plan Commendable Accreditation status. NCQA is a private, nonprofit organization dedicated to improving health care quality.
  • Wellmark’s Customer Service department delivers a consistent 95 percent response rate when receiving incoming calls from members and health care providers.

To request further details about our Quality Management Program email AccreditationMailbox@wellmark.comSend Email or call 1-800-694-4104.