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Providing our members with easy access to high-quality care is foundational to advancing our mission of transforming the health of the communities we serve, one person at a time.

Commitment to Quality and Improved Health Outcomes

Ã山ǿ¼é works every day to deliver access to high-quality healthcare. We verify the credentials and backgrounds of our provider partners to ensure our network quality, with a focus on consumer protections and member and provider experience, using standards supported by the National Committee for Quality Assurance (NCQA). NCQA is an independent organization whose quality accreditation is based on a review of measures, including Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS). Ìý

Key ClinicalÌýInitiatives

Our commitment to healthcare quality is the driving force behind Ã山ǿ¼é’s innovative clinical initiatives, which are designed to deliver evidence-based, person-centered care that improves outcomes and member experience.

Maternal Child Health

As the largest Medicaid and Marketplace managed care organization in the country*, Ã山ǿ¼é plays a critical role in maternal child health care. This unique position gives us the responsibility and opportunity to significantly improve birth outcomes as well as support members before, during and after pregnancy. These objectives were the inspiration behind our flagship maternity program, Start Smart for Your Baby® (SSFB), which began in 2008. SSFB is designed to provide culturally appropriate support to ensure timely access to medical and social services. Ìý

In 2024, several enhancements were made to the program, including:

• Whole health care management support
• Refined and new data science risk stratification models
• Updated notification of pregnancy form
• Trimester-based assessments
• Digital-first member education

*Measured by total membership as of June 30, 2025

Behavioral Health

Behavioral health support is a key component of our whole health approach. The interconnection between physical and behavioral health is increasingly more evident, as are the barriers of stigma and access that surround behavioral healthcare strategies. To ensure our members receive the highest level of care, Ã山ǿ¼é health plans have undertaken several behavioral health initiatives to provide members with reliable, substantive behavioral health resources. Ìý

Ã山ǿ¼é performs targeted outreach to members discharged from inpatient hospitalization for mental illness to help close the gap in follow-up care after hospitalization. Collaboration among behavioral health utilization management, care management, and quality helps to ensure program success. Members in health plans that participate in this program consistently realize year-over-year care gap improvements.

Substance Use Disorder –ÌýOur integrated approach to substance use disorders considers contributing factors such as stress, trauma, social isolation or co-occurring physical and mental health conditions.Ìý

Empowering MembersÌý–ÌýOur Members Empowered to Succeed program uses an integrated, holistic and recovery-centered approach for individuals with mental health needs and outpatient behavioral health services.