Quality Improvement

Scope

The HAP CareSource Quality Management and Improvement program governs quality assessment and improvement activities. The scope includes:

  • Meeting the quality requirements of the Centers for Medicare and Medicaid Services (CMS)
  • Meeting the requirements of the HAP CareSource contract with the Office of Medicaid Policy and Planning
  • Establishing safe clinical practices throughout the network of providers
  • Providing quality oversight of all clinical services
  • Compliance with NCQA accreditation standards
  • HEDIS compliance audit and performance measurement
  • Monitoring and evaluation of member and provider satisfaction
  • Managing all quality of care and quality of service complaints
  • Developing organizational competency of the Institute of Healthcare Improvement’s Model for Improvement
  • Ensuring that HAP CareSource is effectively serving members with culturally and linguistically diverse needs
  • Ensuring that HAP CareSource is effectively serving members with complex health needs
  • Assessing the characteristics and needs of the member population
  • Assessing the geographic availability and accessibility of primary and specialty care providers

The HAP CareSource Quality Management and Improvement program is overseen by the HAP CareSource Chief Medical Officer, and implementation is facilitated by the Vice President, Quality Improvement and Performance Outcomes. On an annual basis, HAP CareSource makes information available about the HAP CareSource Quality Management and Improvement program to members on the HAP CareSource member website.

Clinical Practice Guidelines

HAP CareSource approves and adopts nationally accepted standards and guidelines to help inform and guide the clinical care provided to members. These guidelines allow HAP CareSource to measure the impact of the guidelines on outcomes of care.

The Michigan Quality Improvement Consortium (MQIC) is a group that works to create standard clinical guidelines. These guidelines are for doctors, nurses and health plans. MQIC reviews them every two years. Click the link below to learn more about MQIC. Learn how this information can help you stay healthy.

MQIC | Michigan Association of Health Plans | Michigan Association of Health Plans (mahp.org)

Our member resources include information on health screenings, immunizations and other things you can do to stay healthy. We may also call or send you reminders for health exams and screenings you may need. If you have a long-term health issue like asthma or diabetes, you should:

  • See your PCP on a routine basis.
  • Talk with your PCP about the best plan to take care of your health issue or if you have trouble following your health plan.
  • Take the medications your PCP has given you.
  • Call your doctor to talk about changing the drugs if they make you sick or cause a allergic reaction.
  • Don’t stop taking your medication until you talk to your doctor.