The Quality Improvement (QI) program is an integral part of Ambetter from Arkansas Health & Wellness.  QI supports the Ambetter from Arkansas Health & Wellness' mission to improve the health of all members.  The QI Program continuously monitors the quality of care and services provided to our members in areas such as:

• Acute and chronic care management 
• Behavioral health care
• Compliance with member confidentiality laws and regulation
• Compliance with preventive health guidelines and practice guidelines
• Continuity and coordination of care
• Employee and provider cultural competency
• Member Experience (including satisfaction and grievance system)
• Patient safety
• Pharmacy
• Provider and Plan after-hours telephone accessibility
• Provider appointment availability
• Provider satisfaction
• Selection and retention of providers (credentialing and recredentialing)
• Utilization Management, including under and over utilization

The goal of the quality improvement program is to improve members’ health through meaningful quality improvement activities implemented across all care settings.

Some of our Quality Improvement goals include but are not limited to the following: 

• A high level of health status and quality of life will be experienced by Plan members;
• Network quality of care and service will meet industry-accepted standards of performance;
• Plan services will meet industry-accepted standards of performance;
• Fragmentation and/or duplications of services will be minimized through integration of quality improvement activities across Plan functional areas;
• Member experience will meet the Plan’s established performance targets;
• Preventive and clinical practice guideline compliance will meet established performance targets. This includes, but is not limited to, compliance with immunizations, prenatal care, diabetes, asthma, early detection of chronic kidney disease and EPSDT guidelines (Early Periodic Screening, Diagnosis and Treatment Program);
• Compliance with all applicable regulatory requirements and accreditation standards will be maintained; and
• Evaluate the quality of health care through HEDIS® (Healthcare Effectiveness Data and Information Set).
• Check out our HEDIS® rates and results here (information coming soon).

Click here (information coming soon) if you would like to learn more about Ambetter from Arkansas Health & Wellness QI activities.