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:

• Ensuring members get the care they need, when and where they need it.
• Ensuring that members are receiving quality care.
• Establishing the cultural needs of our members.
• Ensuring member satisfaction.
• Ensuring member/patient safety and privacy.
• Offering a wide variety of provider specialties.
• Monitoring 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 QI goals include the following: 

• Establishing good health and quality of life for all members
• Ensuring care provided by plan healthcare providers meets industry-accepted standards of care.
• Ensuring plan customer service meets industry-accepted standards of performance.
• Providing members with preventive care reminders annually.
• Keeping incomplete or duplicate services to a minimum through QI activities across plan departments.
• Ensuring the member experience meets the plan’s expectations
• Ensuring compliance with all state and federal laws and regulations.
• Evaluating the quality of health care through the Healthcare Effectiveness Data and Information Set (HEDIS®). These scores tell us when you have received the type of care you need.

If you would like more information about our QI Program and our achievements, please contact us at 1-833-270-5443 (TTY: 711) for a copy of our annual QI Program Evaluation.