Quality management program

Our quality management program works to ensure that all our services meet high standards of quality and safety. We aim to: 

• Meet our members’ health care needs and diverse cultural and linguistic needs

• Measure, monitor and improve the clinical care and quality of service our members get

• Institute company‐wide initiatives to improve the safety of our members and communities

• Improve access to health care

• Make sure we obey all the rules, whether they come from federal and state regulators or accrediting groups

We have quality programs so that you can get the care you need quickly. Some of our quality programs are:

• Surveying members and providers to measure satisfaction

• Calling members to remind them to get their care

• Educating members by sending postcards or newsletters

• Reviewing the type, amount and quality of services given to members

• Working with members who have serious health issues through case management

• Reminding providers and members about preventive health care

• Measuring standards like how long it takes for a member to get an appointment

• Monitoring phone calls to make sure your call is answered as quickly as possible and that you get correct information

• Reviewing calls and complaints from members

• Reviewing all aspects of the health plan with health plan staff, providers and members through committees

Throughout the year, we evaluate our quality programs and data trends related to how our members receive health care and preventive care services. We compare our findings to national practice guidelines. We will share this information with you in Quality Matters. You can call Member Services at 1-844-362-0934 (TTY: 711) to request a copy of our quality management program materials and to learn more about what we're doing to improve your care.