Our Dedication to Quality

As a member, your health is our first priority. That’s why we have a Quality Assessment Performance Improvement (QAPI) program. The QAPI program looks for ways to make our services better. That can make it easier for you to stay healthy.

Our goal is to make sure health care and services our members receive are:

• High quality
• Safe
• Appropriate
• Efficient
• Effective

We review our QAPI program each year to see how we are doing. This review includes suggestions for improvement, as well as goals for the next year.

Our mission is to help people get care, stay well, and build healthy communities by creating programs to serve our members who have special health care needs.

Our goals for 2025

The plan will focus on reducing chronic conditions such as cardiovascular disease and diabetes, increasing preventive screenings and medication adherence, and improving health outcomes.

We will also prioritize improving the health of our members and reducing health care disparities by monitoring:

• Access to care and services through assessing the availability and accessibility of providers.
• Compliance with prescribed health screenings.
• Develop member and provider outreach initiatives to improve utilization of services.
• Develop chronic disease management through:
  • Effective care management programs.
  • Designing effective medication adherence programs.
  • Socialize evidence-based clinical practice guidelines to promote implementation of comprehensive medical and health care practices, including preventive, diagnostic and treatment services.
• Promote coordination of care between medical and behavioral health providers, home health care agencies, and long-term care service providers by systematically improving care management communication with these providers
• Address member safety through ongoing monitoring and investigation of root cause analyses and trends for potential quality of care and credentialing/recredentialing issues, as well as addressing issues identified through complaints and appeals.
• Monitor Model of Care (MOC) metric performance toward established goals.
• Empower members to work more collaboratively with their health care providers in implementing their care plans to maintain and/or improve their health.
• Implement other Quality Initiatives to address ongoing support of process improvement, and the adoption of best practices within the managed care industry.

Call Member Services at 1-833-433-3767 (TTY 711), April 1 – September 30, 8 a.m. – 8 p.m., Monday through Friday; or October 1 – March 31, 8 a.m. – 8 p.m., seven days a week.

• Would like to learn more about our QI program and its goals, activities, and outcomes.
• Feel that you did not get quality care. Our QI team will look into the issue.