Improving Health through Quality Improvement
Date: 09/10/25
Superior HealthPlan’s Quality Assessment and Performance Improvement (QAPI) Program aims to plan, implement and monitor ongoing efforts that demonstrate improvement in member safety and overall health-care experience. Superior’s goals and objectives for the QAPI Program include:
- Member safety – Ensuring that the care provided does not harm members.
- Member experience – Making sure members feel valued.
- Efficiency – Helping providers use resources to maximize quality and minimize waste.
- Eliminating disparities – Confirming quality care is reliably received regardless of geography, income, language, or diagnosis.
The QAPI program addresses the efficiency and safety of clinically delivered services and the quality of services provided and monitored by the Quality Improvement Committee (QIC). Providers have the opportunity to collaborate with Superior by volunteering with the QIC or one of its subcommittees. The QIC performs the following functions:
- Provides continuous performance monitoring.
- Identifies potential areas for improvement.
- Improves care through viable interventions.
- Analyzes the effectiveness of the interventions.
- Solidifies goals to obtain quality outcomes at lower costs.
- Enhances the quality of and access to care provided to members.
- Collaborates with providers to develop and strengthen the patient care experience.
The QIC is also responsible for monitoring member outcomes through the Health Effectiveness Data and Information Set (HEDIS®). Rates are audited annually by a certified audit firm and submitted to the National Committee for Quality Assurance (NCQA). Throughout the year, Superior works to improve rates through member and provider interventions, as well as data collection through claims and medical record reviews. Superior Medicaid operates under two licenses, Superior HealthPlan, Inc. and Superior HealthPlan Network, with each license defined by Medicaid product and service delivery area in which it is offered. Superior Marketplace also operates under two licenses, Celtic Insurance Company (EPO) and Superior HealthPlan, Inc. (HMO), with each license defined by how they operate. Below is a summary of Superior’s 2025 HEDIS® performance results comparing Measurement Year [MY] 2024 results against 2023 rates, segmented by Medicaid and Marketplace licensure. MY 2024 data is the baseline year for the Superior HealthPlan Network.
Medicaid
HEDIS MEASURE | MY 2023 Rate | MY 2024 Rate | 75th Percentile Benchmark Goals Met (Y/N) | |||
Superior HealthPlan, Inc. | Superior HealthPlan Network | Superior HealthPlan, Inc. | Superior HealthPlan Network | Inc. | Network | |
Appropriate Treatment for Upper Respiratory Infection (URI) | 91.22% | N/A | 91.13% | 85.24% | N | N |
Cervical Cancer Screening (CCS) | 54.99% | N/A | 59.37% | 74.45% | N | N |
Childhood Immunization Status (CIS)- Combo 10 | 26.28% | N/A | 30.90% | 16.20% | N | N |
Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications (SSD) | 84.22% | N/A | 86.08% | 87.07% | Y | Y |
Follow-Up Care for Children Prescribed ADHD Medication (ADD-E) Initiation Phase | 47.95% | N/A | 48.79% | 45.33% | N | N |
Follow-Up Care After Hospitalization for Mental Illness (FUH) 7 days | 52.22% | N/A | 53.58% | 50.59% | Y | Y |
Follow-Up Care After Hospitalization for Mental Illness (FUH) 30 days | 72.11% | N/A | 73.49% | 72.88% | Y | Y |
Glycemic Status Assessment for Patients with Diabetes (GSD) <8 | 52.80% | N/A | 61.80% | 48.66% | Y | N |
Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM-E) | 52.57% | N/A | 51.51% | 44.21% | Y | Y |
Prenatal and Postpartum Care (PPC) Timeliness of Prenatal Care | 82.97% | N/A | 86.37% | 86.37% | N | N |
Prenatal and Postpartum Care (PPC) Timeliness of Postpartum Care | 73.72% | N/A | 79.08% | 84.18% | N | Y |
Child and Adolescent Well-Care Visits (WCV) | 62.73% | N/A | 65.27% | 63.79% | Y | Y |
Ambetter from Superior HealthPlan
HEDIS MEASURE | MY 2023 Rate | MY 2024 Rate | 75th Percentile Benchmark Goals Met (Y/N) | |||
EPO | HMO | EPO | HMO | EPO | HMO | |
Appropriate Treatment for Upper Respiratory Infection (URI) | 62.34% | 60.67% | 65.62% | 65.68% | N | N |
Cervical Cancer Screening (CCS) | 45.99% | 26.52% | 49.39% | 34.31% | N | N |
Childhood Immunization Status (CIS)- Combo 10 | 19.95% | 16.96% | 21.90% | 15.79% | N | N |
Glycemic Status Assessment for Patients with Diabetes (GSD) <8 | 66.42% | 61.07% | 73.48% | 74.21% | N | N |
Prenatal and Postpartum Care (PPC) Timeliness of Prenatal Care | 76.16% | 64.48% | 79.56% | 64.96% | N | N |
Prenatal and Postpartum Care (PPC) Timeliness of Postpartum Care | 67.15% | 57.42% | 77.13% | 56.20% | N | N |
Child and Adolescent Well-Care Visits (WCV) | 42.91% | 22.92% | 45.00% | 25.54% | N | N |
Note: Superior requires all practitioners and providers to cooperate with all Quality Improvement (QI) activities, maintain the confidentiality of patient medical information and records, and allow Superior to use practitioner and/or provider performance data to ensure success of the QAPI program.
Superior’s Peer Review and Utilization Management committees and Performance Improvement team support QIC. For more information about:
- HEDIS measures, rates, benchmarks, the Quality Improvement (QI) program, or to report a quality issue please contact Superior’s Quality Improvement department at SHP.HEDIS@SuperiorHealthPlan.com.
- The QAPI program, goals and objectives, and quality-related resources and information, visit Superior’s QI Program webpage.