Quality Improvement

Program Purpose

HAP CareSource is committed to providing evidence-based care in a safe, member-centered, timely, efficient and equitable manner. The scope of our HAP CareSource Quality Improvement (QI) program is comprehensive and includes clinical and non-clinical services.

HAP CareSource monitors and evaluates the quality of care, encompassing the safety and service delivered to our members with an emphasis on accessibility to care, availability to care, availability of services and physical and behavioral health care delivered by network practitioners and providers. HAP CareSource also monitors the quality and safety of member services through review of practitioner, provider, hospital, utilization management, care management and pharmacy program results.

Member satisfaction and health outcomes are monitored through routine health plan reporting, annual Healthcare Effectiveness Data and Information Set (HEDIS^®) and the CMS Quality Rating System. In addition, Marketplace members complete the annual Quality Health Plan (QHP) Enrollee Survey to capture member perspectives on health care quality. The QHP Enrollee Survey is a consumer experience survey that assesses the enrollee experience with plans offered through Marketplace plans. The survey includes a set of core questions that address key areas of care and service provided to members.

HAP CareSource is accredited by NCQA. This accreditation status shows the commitment to service and clinical quality that meets or exceeds NCQA’s rigorous requirements for consumer protection and quality improvement as we work to improve members’ health care.

Contact Us

If you would like more information about HAP CareSource Quality Improvement, please call Provider Services, Monday through Friday, 8 a.m. to 6 p.m. Eastern Time (ET) at 1-833-230-2101.