An Oregon-based, not-for-profit health insurance provider, Providence Health Plan is recognized as a national leader in quality, excellence and innovation.
Providence Medicare Advantage Plans recognized for excellence: Highest Medicare ratings for quality and service
Providence Medicare Advantage Plans have been rated among the best in the US for 2018, performing among the top 4 percent in the nation and receiving an overall rating of 5 stars by the Centers for Medicare and Medicaid Services (CMS).
Through the Medicare Star Quality Rating System, CMS uses information from member satisfaction surveys, plans, and health care providers to give overall performance star ratings to plans. A plan can get a rating between one and five stars. A 5-star rating is considered excellent. Star ratings are based on 44 care and service quality measures across five categories that include staying healthy, managing chronic conditions, member satisfaction, customer service, and prescription drugs.
"Reaching this premier level of recognition is evidence of the outstanding quality, patient-centered care and services our members receive," said Dr. Robert Gluckman, M.D., chief medical officer, Providence Health Plan. "To earn overall five stars acknowledges the dedication of teams across Providence, including our medical group, affiliated providers and hospitals to improving the health of the communities we serve."
Providence Medicare Advantage Plans has continually been among the highest-rated Medicare plans in the nation by CMS. It is through the hard work of Providence caregivers that our health plans continue to achieve this high level of recognition, and more importantly, our members are assured of the highest-quality care.
Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
NCQA highest-rated PPO plan in Oregon
The National Committee for Quality Assurance has awarded Providence Health Plan an accreditation status of Commendable for its Oregon Commercial PPO plans. NCQA rates more than 1,000 health plans on a scale of 1-5 based on clinical quality, member satisfaction, and NCQA Accreditation Survey results. In 2017-2018, Providence Health Plan’s commercial plan earned a rating of 4.0 and was recognized by NCQA as the highest-rated PPO health plan in Oregon (out of nine PPO plans). HEDIS clinical quality measure performance is a key driver of NCQA ratings and Providence Health Plan achieved top performance (90th percentile) in six measures, including:
- Follow-up Care for Children Prescribed ADHD Medication - Initiation Phase
- Comprehensive Diabetes Care — HbA1c Control (<8 percent)
- Pharmacotherapy Management of COPD Exacerbation
- Use of Imaging Studies for Low Back Pain
Named among “most admired” Oregon health care companies in 2017
Providence Health Plan has been honored as a "Most Admired" health care company by The Portland Business Journal. Providence St. Vincent Medical Center also made the top 10 list for health care organizations.
Providence Health & Services in Oregon was also recognized in the overall top 10 across all industries. The Business Journal compiled surveys from chief executives in Oregon to determine its "most admired" rankings.
One of Oregon's healthiest employers
Providence Health & Services - Oregon Region ranks among the top 10 healthiest employers in the Portland Business Journal’s 2017 rankings in the over 1,500 employees category.
Service Operations milestones
In 2017, our Service Operations team continued to provide excellent service to our members. Some of their accomplishments include:
- 90 percent of clean claims processed within 30 days
- 668,832 member calls
- 378,485 provider calls answered
- 7,480,934 claims processed
Compassionate involvement in our community
Providence Health Plan has been awarded Portland Business Journal's 2013 Corporate Philanthropy "Innovation in Partnership" award, along with Kaiser Permanente and Oregon Community Foundation, for a collaborative to address mental health and substance abuse in Oregon.
"As health care continues to transform, the health care community is facing unprecedented challenges," said Michael White, chief operating officer, Providence Health Plan. "Responding to these challenges requires innovative solutions, partnerships and processes, such as the one we are being honored for today."
Providence Health Plan and Kaiser Permanente partnered with Oregon Community Foundation to allocate $1.2 million in community benefit grants. The grants help fund services through innovative programs addressing the more than 200,000 low-income Oregonians with mental health and/or substance abuse issues.