Group Health Cooperative of South Central Wisconsin Integrates Health Insurance and Health Care for a Better Member Experience
October 30, 2025 · NCQA Communications
What does high-quality health care look like—and what does it take to get there? We gathered insights and success stories from the top-performing plans in NCQA’s 2025 Health Plan Ratings. High ratings demonstrate a commitment to quality, patient-centered care and continuous improvement. We hope these stories foster shared learning, inspire action and help elevate performance across the industry.
Organization: Group Health Cooperative of South Central Wisconsin
Rating: 4.5 out of 5 Stars
Product Line: Commercial
State: WI
NCQA Health Plan Accreditation Status: Accredited
Group Health Cooperative of South Central Wisconsin’s Quality Story
Group Health Cooperative of South Central Wisconsin (GHC-SCW) is a non-profit, member-owned health plan providing high-quality health care and member-centered service to 70,000 members. As the first HMO in Dane County, Wisconsin, GHC-SCW pioneered a shift in the health care landscape by bringing health insurance and care delivery together.
What does earning a 4.5-star rating from NCQA’s Health Plan Ratings mean to your organization?
Earning a 4.5-star rating from NCQA for our commercial plan is a direct reflection of the commitment to excellence, compassion and constant pursuit of improvement shown by our care teams, administrative staff and every individual who works to serve our members and our community. This achievement highlights the high-quality, safe and compassionate care we provide to our members. Our team understands the meaning and value behind the NCQA rating, supports the efforts that led to this success and proudly celebrates this shared accomplishment.
What strategic priorities guided your journey toward achieving a 4.5-star rating?
Setting targets. We set a goal to reach the NCQA 90th percentile for HEDIS® measures related to diabetes, hypertension and adult preventive care (e.g., cancer screenings, immunizations.) We also focused on building member trust and providing a positive experience to drive improvement in CAHPS® scores.
Improving reporting capabilities. We transformed our reporting capabilities to allow department staff to monitor meaningful, real-time data.
Focusing on continuous improvement. These efforts were strengthened by our use of Lean principles and tools to ensure that our work is aligned with delivering better clinical outcomes and a positive member experience.
What unique processes or tools have you implemented to improve patient experience or clinical outcomes?
We are both a health plan and a care delivery system, so our quality teams maintain a close presence in clinics, enabling ongoing collaboration, education and two-way feedback. These relationships drive progress across clinical quality and patient experience initiatives. Clinically, we enhanced awareness of continuous glucose monitors among members and providers, including outreach to eligible members, provider training and piloting the monitors internally to deepen our understanding of how they work. We also strengthened collaborative care practices across clinical teams to better coordinate treatment.
What lessons did you learn that could help other health plans improve performance?
One key lesson is the vital importance of addressing social determinants of health, which play a significant role in closing care gaps. By identifying and actively addressing barriers, we can deliver more effective, equitable care and achieve better outcomes. Another important insight is the value of incorporating member feedback to help shape programs that truly reflect and respond to members’ needs.
How does your organization cultivate a culture of quality?
We place our members at the heart of everything we do, leveraging our integrated care model to deliver personalized, proactive care. Our culture is built on strong collaboration, a commitment to excellence and a mindset of continuous improvement that is guided by Lean principles. This approach empowers our workforce at every level to eliminate waste, streamline processes and focus on delivering the best possible health outcomes. Staff input is highly valued and encouraged, driving initiatives that not only improve clinical outcomes, but also enhance the overall member experience.
What are your next steps to continue improving HEDIS and CAHPS scores?
We will maintain HEDIS and CAHPS improvement as core components of our strategic plan, keeping these metrics aligned with our True North to deliver exceptional quality and service, and ensure ongoing focus on what matters most to our organization and members.
Learn More
Explore the 2025 Health Plan Ratings and find out how we calculate the ratings.
Learn more about NCQA’s Health Plan Accreditation.
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).
