Our Quality Improvement Program
At Clover Health our team runs a Quality Improvement (QI) Program all year long. We use this program to monitor the care and service our members receive.
Our goal is to find ways to make care better and then put those changes in place. Through this program we focus on medical care, preventive care, and member experience.
What Our Program Covers
- Support of care that helps protect your health, including long-term health conditions and mental health care.
- Your safety, including the proper use of medicine and support after a hospital stay.
- Teamwork among your doctors, specialists, and pharmacy so your care stays connected.
- Your experience with your health plan, based on surveys like the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.
How We Check Our Progress
We track how we are doing with nationally recognized quality measures, including HEDIS (the Healthcare Effectiveness Data and Information Set), the Health Outcomes Survey (HOS), and CAHPS. We compare our scores to national goals, set our own goals, and review and report our results every year.
*We are available from 8 am to 8 pm local time, 7 days a week. From April 1 through September 30, alternate technologies (for example, voicemail) will be used on the weekends and holidays.
Clover Health is a PPO and HMO organization with a Medicare contract. Enrollment in Clover Health depends on contract renewal. Star ratings apply to CY2026. Each year, Medicare evaluates plans based on a 5-star rating system. Please check Medicare.Gov for the plan rating in your area.
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Regulatory requirements
Compliance note
The § 422.111(b)(9) member-disclosure duty is distinct from the “available to CMS upon request” provisions in § 422.152. The mandatory QI program is anchored at § 422.152(a).