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.

 

 

 

Quality Management Plan

Each year a Quality Management Plan is developed as a guide to the Quality Management Program. It includes the goals, objectives, scope, principles, authority, organizational model, oversight, and reporting and evaluation requirements of the Quality Management Program.
Quality Management Plan

 

 

Current Quality Management Projects

The Quality Management Program includes many quality improvement projects. Some quality improvement projects are specific to a line of business but the goal is to have each project cross all lines of business as appropriate. Projects are designed to improve the health outcomes of our members.
Project List