Provider Quality Improvement

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.


Healthcare Effectiveness Data and Information Set (HEDIS)

Our Quality Improvement Program is focused on improving member healthcare outcomes. We participate in a nationally recognized measurement activity called Healthcare 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.