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Quality management & improvement efforts

Quality improvement strategy

We’re 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 give you and your doctors 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 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 2019, 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 we’re 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, including rating member satisfaction and putting in place activities to help improve patient safety
  • Making sure 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

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       Page last updated: Mon Oct 21 11:47:42 EDT 2019

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