Quality of Care

Tufts Health Plan is committed to improving the quality of clinical care provided by its participating providers and services delivered to its members. We have programs in place to continuously monitor and evaluate the quality of member care, improve member health outcomes, access to care and quality of service.  We focus on providing a supportive, collaborative environment to help our participating providers improve the safety of their practices through member and provider education, along with linking technology solutions to patient safety and quality improvements.  Our commitment has consistently produced high ratings year after year for the quality of our health plans by the National Committee for Quality Assurance and the Centers for Medicare and Medicaid Services.

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Now you can find our HEDIS tip sheets for both Harvard Pilgrim Health Care and Tufts Health Plan in one handy spot. Visit our new HEDIS Tip Sheet page for resources to learn more about HEDIS measures and best practices aimed at helping your practice optimize HEDIS scores.

The Massachusetts Statewide Quality Advisory Committee (SQAC), which was established by Chapter 288 of the Acts of 2010 and reestablished by Chapter 224 of the Acts of 2012, is comprised of various experts in the health care industry and is tasked with recommending a Standard Quality Measure Set (SQMS).

The initial recommended SQMS included 130 measures. Each year the SQAC reviews and adjusts the measure set.

The SQMS covers a variety of clinical areas, such as preventive health, chronic disease management, pediatric, maternal and neonatal health, mental health, and substance abuse, and also includes the following measures mandated by the State Legislature:

  • CMS hospital process measures for AMI, CHF, pneumonia and surgical infection prevention
  • Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS)
  • Healthcare Effectiveness Data and Information Set (HEDIS®), and
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS, Patient Experience Survey)

Tufts Health Plan utilizes the SQMS in its quality initiatives, including when calculating a Top Quality Recognition for hospitals and physicians, the quality score used in determining provider tier placement for tiered products, as well as when defining quality incentives included in provider contracts.

For more information, please visit chiamass.gov/sqac.

Evidence-based information

Tools to manage your patients' care

Quality Improvement

Resources