Quality Assessment Improvement Program

The program has several goals:

• Better coordination of care
• Improve the member and provider experience
• Reduce health differences among groups
• Promote disease prevention and manage chronic conditions
• Diagnose and treat illnesses earlier
• Promote healthy lifestyles and preventive care
• Reduce unnecessary hospital stays and emergency room visits
• Improve behavioral health care

We focus on the quality of medical and behavioral health care for our members. This includes:

• Adequate access to primary and specialty health care providers and services
• Member feedback
• Continuity and Coordination of Care
• Quality of physical and behavioral health care
• Population Health

We use a system of checks and balances to achieve our goals. This includes:

• Performance improvement projects
• Collecting and analyzing data
• Monitoring service usage
• Addressing the needs of individuals with special health care requirements

Our strategies include:

• Helping health care workers provide good care
• Collecting and analyzing data to find ways to improve
• Ensuring members have access to doctors and specialists
• Promoting preventive care, cancer screenings and managing chronic illnesses
• Meeting cultural and linguistic needs of members
• Reviewing member satisfaction to identify areas of improvement
• Encouraging care management to help members with medical and mental health needs

Each year, we select projects to improve care and services for members. Here are some current projects:

• COPD or Asthma in Older Adults: Support members with COPD by recommending they see a health care practitioner at least once a year. This helps to reduce hospital admissions.
  
  
• Diabetes Care: Support members with diabetes to see a health care practitioner at least once a year. This helps to reduce hospital admissions for diabetes complications.
  
  
• Substance Use Disorders: Support members with substance use disorders by recommending they see a health care practitioner at least once a year. This helps to reduce emergency and hospital admissions.