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The Quality Improvement Program:

• Checks providers to be sure you have access to a qualified health care team.
• Reviews and takes action when there is an issue with the quality of care that has been provided.
• Promotes safety in health care through education for our members and our providers.
• Provides a Grow and Stay Healthy Guide to help members know what services are needed and when.
• Provides a Guide to Accessing Quality Health Care to help members access our programs and services.
• Evaluates the quality of health care through HEDIS^® (Healthcare Effectiveness Data and Information Set).
  • These scores tell us when you have received the type of care you need. The scores look at how often members receive services such as flu shots, immunizations, eye tests, cholesterol tests and prenatal care for members who are pregnant.
• Surveys members’ satisfaction with care. One type of survey is called CAHPS^® (Consumer Assessment of Healthcare Providers and Systems).
  • This tells us if you are happy with your care and your provider. It also tells us what we can make better for our members. Some things are getting the right type of appointment at the right time and having enough providers to take care of your needs.

^*You may request printed copies of all content posted on our website.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CAHPS^® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

Healthcare Effectiveness Data and Information Set (HEDIS^®)

Affinity by Molina Healthcare uses the Healthcare Effectiveness Data and Information Set (HEDIS®) tool each year as a way to measure quality. This is done by looking at the type of care and services provided. HEDIS® is maintained by the National Committee for Quality Assurance (NCQA). This allows the review of certain aspects of care. This includes clinical and non-clinical care. It also shows where plans can improve care and service. Affinity's goal is to be better than 75% of other Medicaid health plans in the nation.

Detailed results can be found by clicking the link below:
HEDIS^® Annual Trends

If you have any questions or would like additional information about HEDIS®, please contact Affinity's Member Services at (800) 223-7242.

*You may request printed copies of all content posted on our website by calling the Member Services phone number on your member ID card.

HEDIS® is a Registered Trademark of the National Committee for Quality Assurance.

Consumer Assessment of Healthcare Providers and Systems (CAHPS^®)

The CAHPS® (Consumer Assessment of Healthcare Providers and Systems) is a program managed by the U.S. Agency for Healthcare Research and Quality (AHRQ) and administered by the NY State Department of Health. CAHPS® surveys are used by the National Committee for Quality Assurance (NCQA), a non-profit group that wants to improve health care quality. Affinity by Molina Healthcare Members are surveyed each year by an independent organization using the CAHPS® Adult and Child Medicaid Health Plan surveys. These surveys measure how happy members are with their health plan and the care received from doctors. Affinity’s goal is to be better than 75 percent of Medicaid health plans in the nation who report their results to NCQA.

Detailed results can be found by clicking below:

CAHPS^® Annual Trends

If you have any questions or would like additional information about CAHPS® please contact Member Services at (800) 223-7242; TTY/TTD 711.

*You may ask for copies of all content on our website by calling the Member Services phone number on your member ID card.

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

Affinity by Molina Healthcare wants you and your family to be safe and healthy. We have a Patient Safety Program to help us meet this goal. This program gives you the safety facts so you can make better health care choices. Here are a few of the things we do to improve safety:

• Keep track of our members’ complaints about safety problems in their provider’s office or hospital.
• Look at reports from groups that check hospital safety. Reports tell us about things such as if there was enough staff in the intensive care unit (ICU), use of computer drug orders and so forth.
• Help members coordinate care when moving from one setting to another (e.g., hospital to home).
• Educating members about what to ask when you see a doctor.

Groups that check safety:

• Leap Frog Quality Index Ratings
• The Joint Commission National Patient Safety Goal Ratings

Affinity members can look at these websites:

• To see what hospitals are doing to be safer.
• To know what to look for when they pick a provider or a hospital.
• Get information about programs and services for members with problems like diabetes and asthma.

^*You may request printed copies of all content posted on our website.

Your Rights

As a member of Affinity Health Plan, you have a right to:

• Get quality health services with care and respect no matter what your race, color, religion, sex, age, homeland, sexual orientation, physical or emotional state.
• Get information that is clear, complete, and in your language from your Primary Care Physician (PCP) and other doctors. It will say what is wrong, and what can be done for you.
• Get a second opinion about your care and treatment.
• Name someone to decide about your care, if you are too sick to know what to do.
• Know what is to be done in any surgery and have the chance to agree to it before anything is started.
• Say no to treatment when the law allows and be told clearly what will happen if you do so.
• Get a copy of your health record and talk about it with your doctor.
• Have your treatment and records kept private (except as the law or a contract may call for).
• Get thoughtful and respectful care in a clean and safe setting free of unwanted restraints.
• Say your views to Affinity Health Plan staff, including any complaints you may have, and get a thoughtful, helpful answer.
• Make a written or spoken complaint to Affinity Health Plan at any time.
• Make a written or spoken complaint to the New York State Department of Health or your Local Department of Social Services.
• Use the State Fair Hearing process.
  
  

Your Responsibilities

As a member of Affinity Health Plan, you have the responsibility to:

• Use the hospital Emergency Room only for real emergencies that might cause death or lasting harm.
• Keep your medical appointment. And to call if you are either going to be late or must can cancel your appointment.
• Talk over your health care needs with your Affinity doctor and follow the care you both agree on.
• Listen to your PCP’s advice and ask questions when you’re in doubt.
• Call or go back to your PCP if you do not get better, or ask for a second opinion.
• Call your PCP or Affinity Health Plan if you need care at night or on the weekend.
• Tell us if you have problems with any health care staff. Call Customer Service.
• Tell Affinity Health Plan if your address and/or phone number changes.
• Learn how your health care system works.
• Follow the rules in your Member Handbook.
• Tell Affinity if you become eligible for Medicare or get other insurance coverage.
• Let Affinity Health Plan staff know if your rights have not been honored.

• You have a problem with the quality of your care.
• Wait times are too long.
• Your doctors or the doctor’s staff behaves badly.
• You can’t reach someone by phone.
• You can’t get info.
• A doctor’s office is not clean.
• Your enrollment ends and you didn’t want it to.
• You can’t find a provider in your area.
• You can’t get your drug. 

• Stop, suspend, reduce or deny a service.
• Deny payment for services provided. 

We want you to have access to the complaint, grievance or appeal process. The Member Services Department can help you with this process. They are free by calling (800) 223-7242, Monday to Thursday, from 8 a.m. - 5 p.m. and Friday, 9 a.m. – 5 p.m. TTY/TDD: 711.

If you wish to talk in your own language, we can help. A translator is available to talk with you and help you file the request. This service is free to all members. We can help you through each step.

HOW TO:

• How to file a complaint or grievance
• How to file an appeal
• Request a Medicaid Fair Hearing

• Do not give your Affinity Healthcare ID card, Medical ID Card, or ID number to anyone other than a health care provider, a clinic, or hospital, and only when receiving care.
• Never let anyone borrow your Molina Healthcare ID Card.
• Never sign a blank insurance form.
• Be careful about giving out your social security number.