Quality Improvement Program

Your care means a lot to us. CareSource Georgia Quality Management and Improvement program is to make sure we have resources to:

  • Coordinate care
  • Promote quality
  • Better performance and efficiency on an ongoing basis
  • Improve the quality and safety of clinical care and services for members

Quality Metrics

CareSource Georgia is always reviewing our care and services to you. This is done by monitoring and evaluating programs to better outcomes.

CareSource uses HEDIS to measure the quality of care delivered to members. It is one of the most used health care measurement in the United States. HEDIS is developed and maintained by the NCQA. HEDIS is used by America’s health plans to measure important care and services. It also allows for comparisons across health plans. It shows plans’ results in state and federal performance measures and HEDIS benchmarks. HEDIS measures are based on evidence-based care. They address the most pressing areas of care. Some quality measures are:

  • Wellness and prevention
  • Preventive screenings
  • Well-child care
  • Chronic disease management
  • Comprehensive diabetes care
  • Controlling high blood pressure
  • Behavioral health
  • Follow-up after hospitalization for mental illness
  • Antidepressant medication management
  • Follow-up for children prescribed ADHD medication
  • Safety
  • Use of imaging studies for low back pain

CareSource also uses the annual member survey, CAHPS surveys. This survey lets you rate up on health care quality. CAHPS is run by the US Department of Health and Human Services ― Agency for Healthcare Research and Quality (AHRQ). Potential CAHPS measures may be:

  • Customer service
  • Getting care quickly
  • Getting needed care
  • How well doctors communicate
  • Ratings of all health care, health plan, doctor, specialist

Preventive Guidelines and Clinical Practice Guidelines

CareSource approves and adopts nationally accepted standards and guidelines. This is to help inform and guide the clinical care. Guidelines are reviewed and approved by the CareSource Clinical Advisory Committee. This is done at least every two years. More often if it is necessary. The guidelines are then presented to the CareSource Quality Enterprise Committee. These guidelines let CareSource measure the impact of care outcomes . Guidelines are identified through analysis of CareSource members. Guidelines may be, but are not be limited to:

  • Preventive health
  • Behavioral health (e.g., depression, ADHD, substance use disorder)
  • Chronic condition management (e.g., hypertension, diabetes, cardiovascular disease, cerebrovascular disease and chronic obstructive pulmonary disease)
  • Population health (e.g., obesity, tobacco cessation)

Clinical practice guidelines and health information are available to members by newsletters, website, or upon request. Preventive Guidelines and Health Links are available to members and providers website or print.

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

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

Member Services: 1-855-202-0729 (TTY: 1-800-255-0056 or 711), Monday – Friday 7 a.m. – 7 p.m.