The Quality Improvement (QI) program is an important part of your Health Plan.  The QI department supports our goal of improving member healthcare. 

The QI Program monitors the quality of care and services provided in the areas below:

• Making sure members get the care they need, when and where they need it
• Making sure that members are receiving quality care
• Cultural needs of our members
• Member satisfaction
• Member/Patient Safety and Privacy
• Offering a wide variety of provider specialties
• Health plan services members are using

The goal of the QI program is to improve member health. This is achieved through many different activities. 

Some of our Quality Improvement goals include the following: 

• Good health and quality of life for all members
• Care provided by Plan Healthcare Providers meets industry-accepted standards of care
• Plan customer service meets industry-accepted standards of performance
• Provide members with Preventive Care reminders annually
• Incomplete or duplicate services will be kept to a minimum through QI activities across Plan departments
• The Member experience will meet the Plan’s expectations
• Compliance with all State and Federal laws and regulations
• Evaluate the quality of health care through HEDIS® (Healthcare Effectiveness Data and Information Set). These scores tell us when you have received the type of care you need.
• Check out our HEDIS® rates and results here (information coming soon).

Ambetter QAPI Evaluation Reports (PDF)