Quality Management

Quality Management Program

The purpose of the Quality Management Program is to monitor the care provided to our members to assure that they receive quality health care services. The program has many components such as a Quality Management Plan, numerous Quality Improvement Projects, and a Chronic Care Improvement Program (with components of case management, evidence-based clinical practice guidelines, member education, outcome measurements, etc.). A yearly evaluation is done to look for opportunities for improvements in the Quality Management Program.

Clinical Practice Guidelines

Evidence-based clinical practice guidelines are developed to assist providers and members in making decisions about appropriate health care for specific clinical circumstances including "self-management" of chronic diseases. The guidelines are intended to improve the quality and consistency of care provided at the provider level. A physician champion is utilized in the development of these guidelines prior to the approval of each guideline by our Quality Management Committee and then they are disseminated to providers.