Our Dedication to Quality
As a member, your health is our priority. The Quality Assessment and Performance Improvement (QAPI) program helps you get the care you need. The program also looks for ways to make our services better.
QAPI Program Features
The QAPI program gives us a structure and guidelines for medical clinical care, behavioral clinical care, and other member services. It works to improve the quality of your health care and services.
The QAPI program helps members improve their health and wellness by:
- Developing programs for members with special needs.
- Offering programs that help members manage their health.
- Arranging home visits and wellness events.
- Making health education available to members.
- Planning events to help you get care, find resources, and learn better ways to take care of you.
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 2024
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 with our efforts to:
- Monitor access to care and services through assessing the availability and accessibility of providers.
- Monitor compliance with prescribed health screenings.
- Outreach to members and providers to improve utilization of services.
- Develop chronic disease management through:
- Effective care management programs.
- Designing effective medication adherence programs.
- Distribute 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
- Monitor Model of Care metrics toward established goals.
- 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.
- 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 1-833-535-3767 (TTY 711), October 1 – March 31: 8 a.m. - 8 p.m., seven days a week. April 1 – September 30: 8 a.m. - 8 p.m., Monday through Friday if you:
- Would like to learn more about our QAPI program and its goals, activities, and outcomes.
- Feel that you did not get quality care. Our Quality Management team will look into the issue.