About the Care You Receive
Preventive Health Guidelines
Capital Health Plan provides access to recommendations for screening tests, counseling, and immunizations to help prevent illness.
The topics in the guidelines are updated as new research becomes available. The U.S. Preventative Service Task Force owns and regularly updates a research database that makes it simple to browse by topic and explore details related to each one.
The U.S. Preventative Services Task Force is an independent, non-governmental panel of experts in prevention and primary care, convened by the Public Health Service to rigorously evaluate clinical research in order to assess the merits of preventive measures. Their recommendations are given a “grade” according to how strongly they are supported by scientific evidence.
- Grade A and Grade B services are recommended.
- Grade C services are not routinely recommended, but may be appropriate for some people.
- Grade D services are NOT recommended because possible harms are deemed to outweigh benefits.
Do keep in mind that these are recommendations for care for people who do not have symptoms of a particular health problem. For example, a guideline for mammography screening would not apply to a woman with breast-related symptoms. Any decisions related to tests and care for you are made in consultation with your primary care physician.
Population Health
Within the Population Health Program, our Disease Management Programs offer comprehensive services to help members manage chronic conditions. Additionally, health and wellness education, decision support, and symptom management are available through Healthwise® Knowledgebase and the CHP Health Information Line.
- Disease management programs are designed to support and reinforce the treatment plans of each member’s primary care physician. Program members are eligible to receive:
- Access to nurses and other health professionals who can assist with self-management.
- Educational materials, both printed and web-based, through Healthwise® Knowledgebase.
CHP members are automatically enrolled when they are identified as having either diabetes or vascular disease.
Disease management programs are based on clinical practice guidelines approved by CHP’s Quality Improvement Committee.
Understanding Quality
From the local to the national level, Capital Health Plan has a reputation for the quality of care and service. We consistently earn:
- Excellent accreditation ratings
- Industry-leading member satisfaction
- Low rates of voluntary disenrollment
Capital Health Plan’s Quality Improvement Program ensures that we consistently provide health care services that are:
- SAFE: Ensuring that health care services provided for members do not cause harm
- EFFECTIVE: Providing services based on scientific knowledge to all who could benefit and not providing unnecessary care to those who don’t
- PATIENT-CENTERED: Offering care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions
- TIMELY: Reducing delays for both those who receive and those who provide care, and providing care when and where it’s likely to be most effective
- EFFICIENT: Providing care that minimizes the waste of equipment, supplies, and time
- EQUITABLE: Providing a consistent level of care for all members
Improving Services for Members
Our quality improvement (QI) efforts help improve the health and satisfaction of our members. Click on the links below to review a copy of our current QI Program Description and Workplan, and an evaluation of the status of our QI activities. If you would like additional information, or need a copy of these documents mailed to you, contact our Capital Health Plan Member Services.
Accreditation and Quality Report Cards
The National Committee for Quality Assurance (NCQA) is an independent, not-for-profit organization dedicated to assessing and reporting on the quality of health plans. CHP has maintained an accreditation rating of “Excellent”—the highest accreditation rating possible from NCQA—since 2001. Click on the NCQA website below to request a report card for CHP. The report card will explain how CHP is currently rated for the following topics:
- Staying Healthy
- Living with Illness
- Access & Service
- Qualified Doctors and Providers
If you need additional resources for evaluating health care doctors and providers, check the following websites: