Quality Improvement Program

The Upper Peninsula Health Plan (UPHP) is a consumer-centered provider service organization managing the care of members across all fifteen Upper Michigan counties.  In 2021, UPHP earned a renewal of its accreditation status as a Medicaid health maintenance organization from the National Committee for Quality Assurance (NCQA).

The NCQA is an independent, not-for-profit organization dedicated to assessing and reporting on the quality of managed care plans, managed behavioral healthcare organizations, preferred provider organizations, new health plans, physician organizations, credentials verification organizations, disease management programs and other health-related programs.  Accreditation reflects a health plan’s ability to work with its members, providers, and community to improve healthcare access, delivery, and outcomes.

Consumers can easily access organizations’ NCQA statuses and other information on health care quality on NCQA’s website at www.ncqa.org, or by calling NCQA Customer Support at (888) 275-7585.

The UPHP Quality Assessment and Improvement and Utilization Management (QAI/UM) Program is an ongoing process that takes place throughout the year that addresses:

• The quality and safety of clinical care.
• The quality of service.
• The members’ experience with their providers and the health plan.

Each year UPHP evaluates:

• Member access to care.
• Provider performance against national standards.
• Member/provider surveys, complaints, and grievances.
• Service utilization processes.

Two tools used to measure the plan’s performance include:

• Consumer Assessment of Healthcare Provider and Systems (CAHPS)
  • A survey that asks individuals and families about the health care they are receiving.
  • UPHP receives feedback as to whether members are happy with their care and their doctors.

• Healthcare Effectiveness Data and Information Set (HEDIS)
  • Measures performance of care and services using clinical guidelines.
  • Allows UPHP to compare the plan’s performance against other health plans.
  • Measured annually.

For additional information on the QAI/UM Program or to receive a copy of the most recent QAI/UM Summary Report ,call UPHP Customer Service at 1-877-349-9324 (TTY: 711), Monday through Friday from 8 a.m. to 9 p.m. Eastern time. The call is free.

You can also review the MDHHS Medicaid Quality Check Up.