Provider Quality Improvement
Our Health Plan has an ongoing Quality Assessment and Performance
Improvement (QAPI) program that is comprehensive in scope and focuses its
utmost attention on the quality of clinical care and services to our
members. The program is tailored toward ensuring that members receive
preventive health care in a timely manner and providing care management to
individuals with special health care needs. The QAPI program adheres to
state and federal requirements and is overseen by the Governing Board of
Directors and Quality Improvement Committees.
Performance improvement and measurement is fundamental to the QAPI program.
What cannot be measured cannot be improved. Therefore, it is through
analysis of encounter data that we are able to identify gaps in care and
recommend opportunities for improvement. The QAPI program is always seeking
provider involvement, feedback and recommendations for improving the
delivery of care and services.
Information on Quality Improvement Projects is available upon request.
Health Care Effectiveness Data and Information Set (HEDIS)
Our Quality Improvement Program is focused on improving member health care
outcomes. We participate in a nationally recognized measurement activity
called Health Care Effectiveness Data and Information Set (HEDIS).
Our HEDIS measures compliance with clinical elements such as breast cancer
screening, colorectal cancer screening and diabetic care on preventive
screenings. Reviewing our performance on HEDIS measures not only
demonstrates our commitment to quality, it also helps us identify areas for
improvement. HEDIS was designed to compare health plan performance across
plans and against benchmarks. Annually we share our results with our high
volume providers stating their individual performance as well as the
overall agency performance for HEDIS.