Members

Quality Improvement Program

duals_understanding_p

The Quality Improvement (QI) Program:

  • Checks providers to be sure you have access to a qualified health care team
  • Reviews and takes action when there is an issue with the quality of care that has been provided
  • Promotes safety in health care by educating for our members and our providers
  • Provides a Grow and Stay Healthy Guide to help members know what services are needed when
  • Evaluates the quality of health care through HEDIS® (Healthcare Effectiveness Data and Information Set)
    • These scores tell us if you have received the preventive screenings and treatment care you need. The scores look at how often members receive services such as flu shots, immunizations, eye tests, cholesterol tests and prenatal care for members who are pregnant
    • Check out our HEDIS® rates and results
  • Surveys members' satisfaction with health care. One type of survey is called CAHPS® (Consumer Assessment of Healthcare Providers and Systems)
    • This tells us if you are happy with your care and your provider. It also tells us what we can do better for our members, like getting the right type of appointment at the right time and having enough providers to take care of your needs
    • Check out our CAHPS® results 

 

To learn more or to request a copy of our QI program, you can call Member Services. For more information about quality improvement programs for pharmacy, please visit the Prescription Drugs page.

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

*Printed copies of information posted on our website are available upon request.