Our Quality Commitment

Tufts Health Plan is committed to improving the health care quality and safety for you and our community

It is one of our core missions and is an ongoing effort and is evidenced by the following initiatives and recognitions.

Accreditation

The National Committee for Quality Assurance

Since 1999, the NCQA, a nonprofit organization dedicated to measuring the quality of America's health care, has awarded Tufts Health Plan HMO and POS and Tufts Medicare Preferred, Excellent Accreditation - the highest possible achievement for consumer protection, quality improvement, and clinical effectiveness. Tufts Health Plan HMO POS and Medicare Preferred HMO have held the highest accreditation status available since 1996. Tufts Health Plan PPO was awarded Full Accreditation in 2006, the highest accreditation status available to Preferred Provider Organizations.

Quality network of providers

Tufts Health Plan recognizes that improving health care quality is a team effort and that’s why our network includes some of the best doctors and leading hospitals in the world.

  • Massachusetts Health Quality Partners (MHQP) is a broad-based coalition of doctors, hospitals, health plans, purchasers, consumers, and government agencies that work together to promote the improvement of quality health care in Massachusetts. MHQP provides reliable data to help doctors improve the quality of patient care and to help consumers make informed choices about their health care.
  • Leapfrog Group Initiatives – The Leapfrog Group is a national organization representing some 130 public and private organizations that provide health care benefits. The Leapfrog Group works to improve hospital systems that have the potential to harm patients. Tufts Health Plan requests that Massachusetts hospitals report their compliance with Leapfrog initiatives annually.
  • Quantum® Alert – All prescriptions filled by Tufts Health Plan members at any Caremark-participating pharmacy are screened for safety and appropriateness: drug-age conflict, drug-drug interaction, drug-pregnancy conflict, drug-disease conflict, late refill, refill too soon, therapeutic duplication, low daily dose, excessive use, and high daily dose.
  • PCP Medical Record Reviews – Primary Care Provider medical record reviews are performed periodically on certain PCPs to assess compliance with standard medical record keeping and documentation practices.

Promoting quality and safety by empowering our members

We empower our members to take an active role in the care of themselves and their families – to ask questions, understand conditions and treatments, and evaluate options.

  • Choosing quality doctors
  • Choosing quality hospitals
  • Health information and tools
  • Well magazine
  • Preventive Health & Immunization Guidelines

Improving quality of care and patient safety through partnerships

Tufts Health Plan participates in a number of other collaborations aimed at increasing patient safety, including:

Wellness & Health Promotion Accreditation

Tufts Health Plan became the first health plan in the Northeast – and one of only 20 organizations in the U.S. – to receive the Wellness & Health Promotion (WHP) Accreditation from the NCQA in 2013.

Based upon criteria measuring key areas of wellness and health promotion