Quality Management & Improvement Efforts
Quality improvement strategy
We are working hard to improve the service, quality and safety of health care. One way we do this is by measuring how well we and others are doing.
We work with groups of doctors and other health professionals to make health care better.
Our clinical activities and programs are based on proven guidelines.
We also give you and your doctor information and tools that may help you make decisions.
Program goals
We aim to:
- Meet the members’ health care needs
- Measure, monitor and improve clinical care and quality of service
- Institute company-wide initiatives to improve the safety of our members and communities
- Make sure we obey all the rules, whether they come from plan sponsors, federal and state regulators or accrediting groups
Program scope
We work to make your health care better by:
- Developing policies and procedures that reflect current standards of clinical practice
- Reviewing preventive and behavioral health services, and how care is coordinated
- Addressing racial and ethnic disparities in health care that could negatively impact quality health care
- Monitoring the effectiveness of our programs
- Studying the accessibility and availability of our network providers
- Monitoring the overuse and underuse of services for our Medicare members
- Performing credentialing and recredentialing activities
- Assessing member and provider satisfaction
Program outcomes
During 2018, we are creating a quality management program. This will help guide our efforts to check and assist in the improvement of the clinical care and service that you receive. Some of the steps that we are taking include:
- Ensuring that we have procedures to allow us to check on the care provided to our members
- Establishing policies on member rights, privacy and complaints and appeals, among others
- Creating a structure so we can perform certain activities; these would include things like rating member satisfaction and putting in place activities to help improve patient safety
- Making sure that there are enough health care practitioners and providers to provide care to our members
- Developing descriptions of the Quality Management and Care Management programs
- Making a Quality Management Work Plan
- Ensuring coordination of care through a combined medical and behavioral health care management program
