Network Health’s Strong Data Infrastructure and Continuous Monitoring Leads to Top Health Plan Rating
October 17, 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: Network Health Insurance Corporation
Rating: 5 out of 5 Stars
Product Lines: Medicare
State: WI
NCQA Health Plan Accreditation Status: Accredited
Organization: Network Health Pan
Rating: 4.5 out of 5 Stars
Product Lines: Commercial, Medicare
State: WI
NCQA Health Plan Accreditation Status: Accredited
Network Health’s Quality Story
Network Health is a local, provider-owned health plan that serves individuals, families, employers and Medicare and Medicaid beneficiaries across the state of Wisconsin. Its mission is to create healthy and strong Wisconsin communities.
What does earning a 4.5 and 5-star rating from NCQA’s Health Plan Ratings mean to your organization?
At Network Health, the care and service our members receive are important to us. Our 5-star rating for our Medicare PPO and 4.5-star rating for our commercial plan reflect the high quality of coverage and high level of satisfaction we provide for our members. Obtaining and maintaining our ratings allows current and prospective members to identify Network Health as a high-quality health plan.
What strategic priorities guided your journey to achieve a 4.5 and 5-star rating?
Our strategy stems from a strong data infrastructure, frequent prospective reporting on measure performance and consistent exploration of new data sources. Network Health’s value-based contracts, and the trust we build with providers through monthly member gap data reports, have allowed us to successfully collect and continuously improve the electronic data we receive. In addition to collaborating with our providers, Network Health has also incorporated data from labs, Wisconsin’s Health Information Exchange and the Wisconsin Immunization Registry.
From the member perspective, the quality and population health teams provide case and condition management services, including outreach to assist members with their care and wellness visits, which helps to close member care gaps. We also conduct year-round medical record reviews for certain measures to assist in attaining our goals. Monitoring prospective HEDIS® rates allows us to stay on track and pivot our efforts as needed.
What unique processes or tools have you implemented to improve patient experience or clinical outcomes?
Network Health continually strives to improve the care and service provided to our members. We conduct frequent member outreach calls through our case and condition management team, quality nurses and pharmacy team. For members having difficulty obtaining needed testing, we also offer in-home testing for certain tests.
For our CAHPS® survey, we conduct year-round “proxy” satisfaction surveys to identify areas where we need to focus attention.
What lessons have you learned that could help other health plans improve their performance?
Planning and continuous monitoring are critical because what has worked to improve or maintain results one year may not be effective the next. We created teams to allow for frequent monitoring—not only of rates, but of programs and projects. Recently, we evaluated the impact of certain types of outreach on closing member gaps, and found that although telephonic outreach is effective in closing gaps, the overall return on this effort is limited, based on our quality team’s capacity to make the calls. This analysis helped us fine tune and drill down into the most impactful areas.
How does your organization cultivate a culture of quality?
Network Health includes a 5-star rating as an overall company goal to show that every department within the company is involved and held accountable for our success. We have a slogan—and belief—that “we all have a hand in it.”
What are your organization’s next steps to continue improving HEDIS and CAHPS scores?
We will continue to evaluate the success of current programs and remain flexible as we monitor our rates throughout the year. We also plan to continue member outreach on a real-time basis as members participate in our programs and services.
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).
