Quality Care

AmeriHealth Caritas Pennsylvania has a mission to help people get care, stay well, and build healthy communities.

Our Quality team supports this mission by monitoring the health care and services you and your family get.

Our goal is to improve the health and wellness of our members. The Quality department works behind the scenes, but you can also find us at the front line in your communities. Our team:

  • Offers health and disease programs to our members.
  • Reaches out to members to help them get the care and health education they need.
  • Creates programs to serve our members who have special health care needs.
  • Surveys members and providers and uses the answers to improve our services.
  • Reviews the quality of care and services given by AmeriHealth Caritas Pennsylvania medical, dental, vision, and pharmacy providers.

We look for areas that need improvement.

Here are some of our recent successes and our plans for 2023.

Successes in 2022

  • Achieved 4.5 out of 5 rating from the National Committee for Quality Assurance (NCQA) Medicaid Plans ranking.
  • Maintained NCQA accreditation status of “Excellent” through our dedication to clinical and service quality.
  • Maintained Multicultural Health Care (MHC) Distinction from NCQA.
  • Improved the ratings for Customer Service, Getting Needed Care, and Rating of Personal Doctor.  
  • Met our service goals in Member Services for answering and handling your calls.
  • Expanded our efforts to promote services that meet the cultural and language preferences of our members.
  • Developed and improved initiatives to improve the care our members receive by:
    • Coordinating transportation to appointments.
    • Sending Community Health Navigators to where our members live.
    • Making reminder calls to members about doctor appointments and health screenings.

Plans for 2023

  • Continue to help members get connected with their primary care providers (PCPs) and teach members how to best use urgent care centers. We want members to avoid unnecessary trips to the emergency room if their doctor or an urgent care center can help in implementing their care plans to maintain and/or improve their health, and to reduce health disparities.
  • Improve care of our members who have diabetes by promoting our Diabetes Pathway program, supporting dilated eye exams and A1c screenings by sending text messages to our members.
  • Improve children’s health by increasing the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) visits to their providers.
  • Improve care of our pregnant members with more education about the importance of health care from the minute they know they are pregnant to 6 weeks after delivery to make sure they are healing properly.
  • Educate our members who have high blood pressure and/or heart disease about the best ways to take control of their health and lives by providing blood pressure cuffs to monitor their blood pressure.
  • Help our members on the road to health and wellness by getting the screenings and well visits they need.
  • Maintain our "Excellent" NCQA accreditation status.
  • Continue to expand our efforts to promote services that meet the cultural and language preferences of our members.
  • Improve member satisfaction as measured by overall satisfaction scores.

Call Member Services at 1-888-991-7200 (TTY 1-888-987-5704) if you:

  • Would like to learn more about our Quality program and its goals, activities, and outcomes.
  • Think you or your family did not get quality care. Our team will look into the issue.
  • Are going home from the hospital and don’t have the help and resources you need. Our Care Connectors can help.