NCQA

Commonwealth Care Alliance Rhode Island LLC

Rhode Island

Save and compare

checkmark

Not Accredited

Last update: 11/19/2024
Ratings are updated annually (September)

Health Plan Rating

Partial Data Reported

Insurance Type

Medicare

Product Type

HMO

Next Review Date

N/A

Members Enrolled

355

Evaluation Product

N/A

Cms Contract

H0876

Special Project

CMS

Special Needs

Yes

Plan Detail Ratings

The overall rating score is the weighted average of all measures, not an average of the three composites (Patient experience, Prevention and equity, Treatment).

Note: NCQA used MY 2023 data and percentiles for commercial and Medicaid HEDIS/CAHPS and Medicare HEDIS. NCQA used MY 2022 data and percentiles for Medicare CAHPS and the Health Outcomes Survey. Several reasons could contribute to a plan having a non-numerical rating (Partial Data Reported, No Data Reported). For details about the Health Plan Ratings display rules, visit the 2024 Health Plan Ratings methodology on the 2024 HPR page.

Getting care

I

Getting care easily

Did members get appointments, preventive care, tests and treatment easily?

NA

Getting care quickly

Did members get appointments, preventive care, tests and treatments promptly?

NA

Satisfaction with plan physicians

I

Rating of primary care doctor

Did members rate their primary-care doctors high overall?

NA

Rating of specialists

Did members rate specialists high overall?

NA

Coordination of care

Were members satisfied with how their primary provider coordinated care with other providers?

NA

Satisfaction with plan and plan services

I

Rating of health plan

Did members rate their plan services high overall?

NA

Rating of care

Did members rate their care high overall?

NA

Cancer screening

I

Breast cancer screening

Did members ages 50 to 74 who are recommended for routine breast cancer screening get a mammogram every 2 years?

NA

Colorectal cancer screening

Were members ages 45 to 75 screened for colorectal cancer?

NA

Other preventive services

Influenza immunizations for adults

Did members ages 19 and older receive recommended influenza immunizations?

Td/Tdap immunizations for adults

Did members ages 19 and older receive recommended Td/Tdap immunizations?

Zoster immunizations for adults

Did members ages 50 and older receive recommended zoster immunizations?

Pneumococcal immunizations for adults

Did members 66 and older receive recommended pneumococcal immunizations?

Equity

Race and ethnicity of members

Did health plans have information about their members’ race and ethnicity in order to provide appropriate services?

Respiratory

I

Appropriate testing and care for a sore throat

Were members ages 3 years and older with a sore throat given strep tests and appropriately prescribed antibiotics?

NA

Appropriate antibiotic use for colds

Were members ages 3 months and older with colds not prescribed antibiotics up to 3 days after their diagnosis, as recommended?

NA

Appropriate antibiotic use for acute bronchitis/bronchiolitis

Were members ages 3 months and older with acute bronchitis not prescribed antibiotics in the 3 days after their diagnosis, as recommended?

NA

Steroid after hospitalization for acute COPD

Did members ages 40 and older who were hospitalized or had an ED visit for chronic obstructive pulmonary disease receive systemic corticosteroids within 14 days of discharge?

NA

Bronchodilator after hospitalization for acute COPD

Did members ages 40 and older who were hospitalized or had an ED visit for chronic obstructive pulmonary disease receive a bronchodilator within 30 days of their discharge?

NA

Diabetes

I

Patients with diabetes—blood pressure control (140/90)

Did members ages 18 to 75 with diabetes have their blood pressure below 140/90 at their last visit?

NA

Patients with diabetes—eye exams

Did members ages 18 to 75 with diabetes have a retinal or dilated eye exam?

NA

Patients with diabetes—glucose control

Did members ages 18 to 75 with diabetes maintain their blood sugar level below 8 percent?

NA

Patients with diabetes—received statin therapy

Did members ages 40 to 75 with diabetes who do not have cardiovascular disease receive a statin medication?

NA

Patients with diabetes—statin adherence 80%

Did members ages 40 to 75 with diabetes who do not have cardiovascular disease stay on statin therapy as prescribed?

NA

Patients with diabetes—kidney health evaluation

Did members ages 18 to 85 with diabetes receive a kidney health evaluation?

NA

Heart disease

I

Patients with cardiovascular disease—received statin therapy

Did males ages 21 to 75 and females ages 40 to 75 with cardiovascular disease receive a high or moderate-intensity statin medication?

NA

Patients with cardiovascular disease—statin adherence 80%

Did males ages 21 to 75 and females ages 40 to 75 with cardiovascular disease stay on high or moderate-intensity statin therapy as prescribed?

NA

Controlling high blood pressure

Did members ages 18 to 85 with hypertension have their blood pressure controlled (<140/90 mm Hg)?

NA

Behavioral health—care coordination

I

Follow-up after hospitalization for mental illness

Were members ages 6 and older hospitalized with a mental illness followed up with, within a week after discharge?

NA

Follow-up after ED for mental illness

Were members ages 6 and older with an ED visit for mental illness followed up with, within a week of their visit?

NA

Follow-up after ED for substance use disorder

Were members ages 13 and older with an ED visit for a diagnosed substance use disorder followed up with, within a week of their visit?

NA

Behavioral health—medication adherence

I

Adherence to antipsychotic medications for individuals with schizophrenia

Did members ages 18 and older with schizophrenia or schizoaffective disorder stay on antipsychotic medications as prescribed?

NA

Patients with a new episode of depression—medication adherence for 6 months

Did members ages 18 and older with a new episode of depression take a prescribed antidepressant medication for at least 6 months?

NA

Behavioral health—access, monitoring and safety

Substance use disorder treatment engagement

Did members ages 13 and older with a new episode of substance use disorder engage in treatment within 34 days?

NA

Patient safety and treatment for older adults

I

Avoiding non-recommended prostate cancer screening in older men

Were members 70 years old and older not screened unnecessarily for prostate cancer using prostate-specific antigen based screening?

NA

Avoiding potentially harmful drug and disease interactions in older adults

Were members not prescribed drugs considered potentially harmful because of their disease or condition?

NA

Avoiding high-risk medications for older adults

Were members ages 67 and older not prescribed potentially risky medications?

NA

Managing risk of falls

Were members who fell or had problems with balance or walking seen by a practitioner and receive intervention to lower their risk?

NA

Managing osteoporosis in women after fracture

Did women ages 67 to 85 with a fracture get a bone mineral density test or appropriate drugs in the next 6 months?

NA

Screening for osteoporosis in women

Did women ages 65 to 75 receive osteoporosis screening?

NA

Care coordination

I

Follow-up after ED for multiple high-risk chronic conditions

Were members with multiple high-risk chronic conditions ages 65 and older followed up within a week of their visit?

NA

Transitions of care—notification of inpatient admission

For members ages 65 and older who were hospitalized, did their primary care practitioner or ongoing care provider receive notification of admission on the day of admission through 2 days after admission?

NA

Transitions of care—receipt of discharge information

For members ages 65 and older who were hospitalized, did their primary care practitioner or ongoing care provider receive discharge information on the day of discharge through 2 days after discharge?

NA

Transitions of care—patient engagement after inpatient discharge

For members ages 65 and older who were hospitalized, what percentage were engaged by their primary care team within 30 days after discharge?

NA

Transitions of care—medication reconciliation post-discharge

For members ages 65 and older who were hospitalized, what percentage had their medications reconciled within 30 days of discharge?

NA

Risk-adjusted utilization

I

Plan all-cause readmissions

For members ages 65 and older, how many acute inpatient and observation stays were followed by an unplanned acute readmission within 30 days after discharge compared to the expected?

NA

Emergency department utilization

For members ages 65 and older, how many emergency department visits occurred during the year compared to the expected?

NA

Acute hospital utilization

For members ages 65 and older, how many acute inpatient and observation stays occurred during the year compared to the expected?

NA

Hospitalization for potentially preventable complications

For members ages 67 and older, how many hospitalizations were preventable compared to the expected?

NA

Hospitalization following SNF discharge

For members ages 65 and older, how many discharges from skilled nursing facilities were followed by an unplanned acute hospitalization within 30 days compared to the expected?

NA

OTHER NAMES FOR THIS HEALTH PLAN

Bonus point calculations for Health Plan Ratings are based on a plan’s NCQA Accreditation status as of the last business day in June of the release year.
I = Insufficient data; NC = No Credit; NA = Not Applicable
Contact us at My.NCQA to ask about licensing the ratings data for research or display.

Methodology

Understand how organizations are rated or earn a seal from NCQA.

Learn How

Need More Data?

Get access to valuable insights for your business operations with unparalleled access to health plan performance data and benchmarks.

Get Data

Have Questions?

If you have a specific question, NCQA is ready to help!

Ask a Question

Copyright ©2024 National Committee for Quality Assurance. Review our Terms of Use

rev 4.0.1