Quality

Our Quality Management (QM) program is committed to providing a high standard of quality. We focus on improvement in care and services. We review our QM program every year to assess opportunities for improvement and the need for change for the next year.

You can also help us understand where we need to improve our processes. Your satisfaction with us as your health plan is our goal. Some things we do for our members are:

• Education of prevention and wellness care through telephonic and other outreach for:
  • Well visits and dental visit
  • Lead screening
  • Immunizations for children and adolescents
  • Women’s health screenings like mammograms and cervical cancer screenings
  • Pregnancy care
• Surveying members and providers to measure satisfaction (CAHPS survey/Provider Satisfaction Survey)
• Working with members who have serious health issues through case management
• Giving members information on the website about what health care costs
• 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
• Working with providers to get them all the information needed to provide members with the care they need
• Reviewing calls and complaints from members and providers
• Reviewing all aspects of the health plan through committees that include health plan staff, providers, and members

This list includes just some of our quality programs. Call Provider Services toll-free at 1-855-652-8249 to find out more, or to ask for a written description of our Quality Management Program.