Quality Improvement

The Molina Healthcare Quality Improvement (QI) Program provides the structure and key processes that enable the health plan to carry out its commitment to ongoing improvement of care and service, and improvement of members' health. The QI Program assists the organization to achieve these goals. It is an evolving program that is responsive to the changing needs of the health plan's customers and the standards established by the medical community, regulatory and accrediting bodies.

The key quality processes include but are not limited to:

  • Implementation of programs and processes to improve members' outcomes and health statuses.
  • Collaboration with our contracted provider network to identify relevant care processes, develop tools, and design meaningful measurement methodologies for the provided care and service.
  • Evaluation of the effectiveness of programs, interventions and process improvements and determine further actions.
  • Designing effective and value-added interventions.
  • Continuously monitoring performance parameters and comparing to SWH of NY standards, national and regional benchmarks, as well as regulatory requirements.
  • Analysis of information and data to identify trends, opportunities, and the appropriateness of care and services.
  • Oversight and improvement of delegated functions: Claims, UM and Credentialing.
  • Ensuring a high-quality, adequate provider and Health Delivery Organization network through appropriate contracting, studies, and credentialing processes.
  • Conducting provider satisfaction surveys with specific questions about the UM process, such as determining the level of satisfaction with getting a service approved, obtaining a referral and case management.

 

The QI Program promotes and fosters accountability of employees and network and affiliated health personnel for the quality and safety of care and services provided to SWH of NY Members.

If you would like more information about our QI Program, initiatives, and/or the progress toward meeting our quality goals, please contact SWH of NY Provider Relations.

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