Quality Improvement
We want you to have the best health care available.
Measurement
Our performance, quality, and health outcomes are collected, looked at, and reported to evaluate the care you receive.
Our Quality Department reviews these measures:
- Healthcare Effectiveness Data and Information Set (HEDIS) to measure performance on dimensions of care and service
- Health Outcomes Survey (HOS) to assess patient reported outcomes
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to measure member satisfaction
- Other experience and health outcome surveys
- Any Centers for Medicare & Medicaid Services (CMS) standards for quality and safety
- Clinical service quality improvement projects
- Chronic Care Improvement Programs (CCIP) that identify eligible members and interventions to improve disease management
Performance Evaluation
After performance and quality data is collected, an evaluation is conducted that covers these areas:
- Improving access and affordability of healthcare
- Improving coordination of care and delivery of services
- Improving transitions of care across health care settings
- Ensuring appropriate utilization of services for preventive health and chronic conditions
- Ensuring you receive high quality and safe health care