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Our Quality Improvement program

We are committed to the provision of our well-designed and well-implemented Quality Improvement (QI) program. Our culture, systems and processes are structured around the mission to improve the health of all enrolled members.

Goals and objectives

Goals and objectives

Our primary quality improvement goal is to improve members’ health status through a variety of meaningful quality improvement activities implemented across all care settings and aimed at improving the quality of care and services delivered.

Scope

Scope

The scope of the QI program is comprehensive and addresses both the quality and safety of clinical care and quality of services provided to Aetna Better Health® of Illinois members, including:

 

  • Behavioral health care
  • Dental care
  • Medical care
  • Vision care

 

We incorporate all demographic groups, care settings, and services in QI activities, including:

 

  • Acute care
  • Ancillary services
  • Emergency care
  • Preventive care
  • Primary care
  • Short-term care (this is dependent upon the member’s Aetna Better Health coverage)
  • Specialty care

Credentialing standards

For consideration to participate in the Aetna Better Health network, all licensed physicians and other licensed health care professionals who have an independent relationship with us must complete an application for participation and submit copies of applicable supporting documentation.

Cultural competency plan

Cultural competency plan

We are committed to establishing multicultural principles and practices throughout its organizational systems of services and programs. That commitment is supported by facilitating the process by which we can respond to the health care needs of all individuals, regardless of their ethnicity, culture, religious beliefs, or primary language. Our cultural competency plan is reviewed and updated annually.

Participation in quality improvement

Aetna Better Health requires providers and practitioners to cooperate with all quality improvement activities, as well as allow the use of provider and/or practitioner performance data, to ensure the success of the QI program. If you are interested in learning more about Aetna Better Health's QI Program, please contact us at 866-329-4701 and ask to speak with the Quality Improvement Department.

Learn more

If you have any questions, you can call Provider Services at 1-866-329-4701 (TTY: 711).