Granite Alliance has many different policies and procedures in place to ensure our members are receiving safe and appropriate care that meets the highest quality standards. Review the following information to learn more about the programs we have in place, as well as learn about some of the recognition our plan has received!
We conduct drug utilization reviews for all of our members to make sure that you are receiving safe and appropriate care. These reviews are especially important for members who have more than one doctor who prescribe their medications. We conduct drug utilization reviews each time you fill a prescription and on a regular basis by reviewing our records. During these reviews, we look for medication problems such as:
In addition to reviews while you are filling a prescription - we do retrospective reviews by periodically examining our claims data and other records. If we identify a pattern of inappropriate or medically unnecessary care we will work with your doctor to help correct the problem. Part of our daily review also ensures that all claims are paying appropriately and our members are being billed accurately for their copayments. If a claim happened to be rejected we also review that to ensure that it did reject appropriately. If we have any concerns we will reach out to either you directly, or your pharmacy, to help resolve any potential discrepancies. We do everything we can to make sure you are receiving your medications as needed.
Granite Alliance consistently strives to identify and work towards areas of improvement. We collect feedback from members through inquiries into our call center, grievances filed by members, we conduct surveys, and we hold Focus Groups. Based on feedback we have received we have worked to make improvements in some of the following areas:
This is not an all-encompassing list and we continuously have projects underway to further improve our plan and the benefits we can offer. If you have feedback or suggestions about your plan we encourage you to contact us directly.
Our efforts for Quality Improvement have been nationally recognized and in 2021 we received the PQA Laura Cranston Quality Improvement Award for demonstrating significant improvement in PQA measures of medication safety and appropriate use. The Quality Improvement Award recognizes plans that received a 5-star rating on the 2021 CMS Quality Improvement measure and the greatest combined improvement in star ratings from 2020 to 2021 on the five PQA medication measures used in the CMS program during this period. More information about this award can be found
The Centers for Medicare & Medicaid Services (CMS) creates plan ratings that indicate the quality of Medicare plans on a scale of 1 to 5 stars with 5 stars being the highest rating. Every year, Medicare evaluates plans based on a 5-star rating system. The overall star rating is determined through numerous performance measures across several domains of performance. Each measure is awarded a star rating and the individual measure stars are then aggregated at the domain and summary level. Only a small number of plans receive a 5-star summary rating from CMS, with most plans receiving 3 to 4 stars. Granite Alliance is proud to have earned a 3.5 Star Rating for 2023, and we strive to improve those numbers each year.
The Star Ratings evaluate dozens of measures across the plan, however there is a heavy focus on the following areas:
Member complaints and change in plan’s performance: Measures how often members have problems and choose to leave the plan. It also shows if the plan’s performance has improved.
Member experience with plan’s drug services: Members rate overall satisfaction with the plan.
Customer Service: Evaluates how the plan handles customer requests
Granite Alliance ranks high in Customer Service and Member experience, consistently show a low volume of member complaints, and we have seen improvements in Drug Safety and accuracy of pricing. We continue to improve our scores each year!
Granite Alliance partners with our Pharmacy Benefit Management provider, Prime Therapeutics. They help us manage your prescription drug benefits. Prime Therapeutics strives to provide the same care they would want for their loved ones, by delivering holistic care and deep knowledge to uncover savings and improve health. Through the various solutions that Prime offers they have earned many accreditations from both URAC and NCQA which we are proud to share!
Last Updated Date: 11/18/2023
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