Quality Improvement Program

The Quality Improvement Program

• Checks providers to be sure you have access to a qualified health care team.
• Reviews and takes action when there is an issue with the quality of care that has been provided.
• Promotes safety in health care by educating for our members and our providers.
• Provides a Grow and Stay Healthy Guide to help members know what services are needed when.
• Provides a Guide to Accessing Quality Health Care to help members access our programs and services.
• Evaluates the quality of health care through HEDIS^® (Healthcare Effectiveness Data and Information Set).
  • These scores tell us if you have received the preventive screenings and treatment care you need. The scores look at how often members receive services such as flu shots, immunizations, eye tests, cholesterol tests and prenatal care for members who are pregnant.
  • Check out our HEDIS^® rates and results.
• Surveys members’ satisfaction with health care. One type of survey is called  QHP (Qualified Health Plan Enrollee Experience Survey). 
  • This tells us if you are happy with your care and your provider. It also tells us what we can do better for our members, like getting the right type of appointment at the right time and having enough providers to take care of your needs.
  • Check out our QHP results.
• Establishes a Quality Improvement Strategy to improve health outcomes, reduce hospital readmissions, improve patient safety and reduce medical errors, implement wellness and health promotion activities, and/or reduce health and health care disparities.
• Ensures that the health plan remains accredited by the National Committee for Quality Assurance.

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HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).