Quality Focus
Quality Focus
It is important to us that you experience quality health care and customer service. Your satisfaction matters to us. The Quality Management (QM) program ensures our services meet high standards of quality and safety. We want to make sure you have:
- The right kind of care
- Easy access to quality medical and behavioral health care
- Help with any chronic conditions or illnesses
- Support when you need it most
- High satisfaction with your doctors and with us
Quality Management Program
FSBP’s Quality Management Program works to ensure that all of our services meet high standards of quality and safety. We have quality programs so that you can get the care you need. Some of our quality programs are:
- Surveying members and providers to measure satisfaction
- Calling members to remind them to get their care
- Educating members by sending postcards or newsletters
- Reviewing the type, amount and quality of services given to members
- Working with members who have chronic health issues through case management
- Partnering with vendors to provide value added services like health coaching, sleep support, and digital musculoskeletal programs
- Reminding providers and members about preventive health care
- Measuring standards like how long it takes for a member to get an appointment
- Monitoring phone calls to make sure your call is answered as quickly as possible and that you get correct information
- Reviewing calls and complaints from members
- Reviewing all aspects of the health plan with health plan staff, providers and members through various steering committees
Risk Management Program
- Investigating referrals for potential adverse events or quality of care issues.
- Monitoring health care fraud, waste and abuse.
- Monitoring litigation involving the health plan.
- Analyzing trends from member or provider complaints.
- Analyzing trends from clinical audit and IRR (inter-rater reliability) results to understand the differences in care provided and outcomes achieved.
- Implementing educational programs to minimize the risk of harm to health plan members.
If you have a concern or want to learn more about our quality programs, please call Member Services at 1-202-833-4910.
HEDIS® and CAHPS® Performance Results
FSBP is committed to improving clinical outcomes and member satisfaction with the health plan. HEDIS and CAHPS are a set of performance measures that help us to see how well we perform.
What is HEDIS?
HEDIS is a tool that measures performance in the delivery of medical care and preventive health services. HEDIS is coordinated and administered by NCQA (National Committee for Quality Assurance) and used by the Office of Personnel Management (OPM) for monitoring health plan performance.
Why is HEDIS important?
Health plans use HEDIS results to measure performance, pinpoint quality initiatives, and deliver educational programs for members and providers. HEDIS evaluates both physical and behavioral health clinical practice guidelines (CPG) adherence and provides a consistent way to evaluate the quality of care provided to our members.
How are we improving HEDIS?
To learn how FSBP is committed to improving clinical outcomes, check out the Healthy Living section of the website or click for Adult Health Care or for Kid Health Care.
FSBP’s 2025 results based on NCQA percentile benchmarks*:
*Percentile data is taken from the NCQA Quality Compass® Benchmark and Compare Quality Data using ALOB (All Lines of Business) benchmarks.
| HEDIS Measures | NCQA Percentile Rank |
|---|---|
| Avoidance of Antibiotic Treatment of Acute Bronchitis | 90th |
| Asthma Medication Ratio | 90th |
| Statin Therapy for Patients With Cardiovascular Disease | 75th |
| Use of Opioids From Multiple Providers | 90th |
| Colorectal Cancer Screening | 75th |
| Hemoglobin A1c Control for Patients With Diabetes | 90th |
| Follow-Up After Emergency Department Visit for Substance Abuse | 75th |
| Appropriate Use of Imaging Studies for Low Back Pain | 75th |
| Emergency Department Utilization | 75th |
| Plan All-Cause Readmissions | 75th |
What is CAHPS?
The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) is an annual survey which is used for rating a patient’s health care experiences when navigating the healthcare system. The survey asks patients to report on their experiences with health care services in different settings.
Why is CAHPS® important?
It helps people learn from other patients’ experiences. The survey asks simple questions about things like getting care, talking to doctors, and understanding medications. When patients have good experiences, they are more likely to follow their care and stay healthy.
If you ever receive a survey, please take the time to complete it. We will continue to work hard to offer you great health care and best in class customer service.
How are we improving CAHPS?
FSBP is committed to improving the member experience and overall satisfaction with our services by focusing on the following programs:
- Access to valuable health and wellness tools through the secure member portal
- Tips to stay on top of your health on the go from your smartphone using the Aetna Health App
- Access to a Customer Service team focused on first call resolution and world-class support
- Quick and accurate claims processing and easy to understand Explanation of Benefits (EOBs)
- Easy to use provider search tool updated daily that connects you to our expansive network of providers helping you find the care you need when you need it
- Constant communication to network providers centered around the doctor/patient relationship
FSBP’s 2025 results based on NCQA percentile benchmarks*:
| CAHPS Measures | NCQA Percentile Rank |
|---|---|
| Rating of Health Plan | 50th |
*Percentile data is taken from the NCQA Quality Compass® Benchmark and Compare Quality Data using ALOB (All Lines of Business) benchmarks.
Provider Satisfaction with Utilization Management
FSBP is committed to continually improving provider satisfaction with our plan. We ask providers to share their feedback through short surveys. They can take the survey over the phone after they finish a call with us.
We review their answers to see what we are doing well and what we can do better. We share these results with our quality team at least once a year.
2025 Provider Satisfaction Results
| Category | Actuals | Goals |
|---|---|---|
| Overall Satisfaction | 93.3% | > 90% |
| Care and Effort | 93.1% | > 90% |
| Net Promoter Score | 73.5% | > 60% |
Have questions? We’re here.
We’re here to assist you every step of the way with your health care needs.