Collaborating to ensure quality care
Quality assessment and performance improvement
MI Health Link requires Aetna Better Health℠ Premier Plan to have an ongoing quality assessment and performance improvement program. To follow this, we assess the quality of care and adjust processes and operations to improve the quality of care our members receive. We work with our providers to help make this happen.
Our Quality Assessment and Performance Improvement (QAPI) program was established to improve health care quality, and to promote appropriate, cost-effective use of medical resources. We focus on positive health outcomes for our members using a whole-person approach. Our goal is to improve our members’ biological, psychological and social well-being.
Our Quality Management (QM) department collects data that we use to identify root causes for any issues, develop appropriate solutions, and implement plans to improve health care delivery. These improvements can occur at the individual level or system-wide.
Quality management expertise
Our Quality Management (QM) department works in partnership with providers to continuously improve the care given to our members. It includes the following areas:
- The quality of care review unit monitors the quality of care provided by the network, as well as the review and resolution of issues related to the quality of health care services provided to members.
- The prevention and wellness unit is responsible for quality improvement activities and clinical studies using data collected from providers and encounters.
- The credentialing unit is responsible for provider credentialing activities.
- The special needs unit is responsible for coordination and liaison with acute care behavioral health services.
The QM department is also responsible for developing practice guidelines and policies related to quality management. Whenever possible, we adopt practice guidelines from national organizations known for their expertise in the area of concern. To review these guidelines, see the provider manual.