I AM: A Doctor / Provider
We promote continuous improvement in the quality of health plan member care and service through the health plan's Quality Improvement (QI) Program. Our team routinely monitors and evaluates indicators of performance, such as child and adolescent well care and immunization rates, appropriate diabetes care, dental visits, wait times for routine appointments, and member satisfaction. Health care and service outcomes are also measured through special projects or quality initiatives (QI studies).
QI studies include methodologically sound research projects focusing on areas of high volume or high-risk services. Annually, we review a profile of our membership in order to design initiatives that represent the needs of the health plan members. As a result, we carefully select clinical, preventive health, and service improvement areas for study.
A quality improvement committee and several task forces form the foundation of the QI program. The committee is made up of practitioners, administrators, researchers, and other staff throughout the health plan. Committee members are responsible for setting quality improvement goals for the health plan, monitoring indicators of performance, and approving and evaluating quality improvement initiatives.
The most important component of our program is making sure that health plan network providers participate. Our providers can join sub committees and task forces or serve as "champions" for QI studies. If you are interested in participating in our QI program, or would like more information, please call 702-242-7735.
Each year, we create a quality improvement work plan and continuously evaluate the results of the health plan's efforts. The status and results of quality improvement initiatives are reported to and monitored by the health plan's QI committee. The annual evaluation of the program is also reviewed and approved by the health plan's board of directors.
If you have any comments or questions about QI program evaluation, please call 702-242-7735.
We have a Disease Management Program ready for your patients, our health plan members, to join. Our team works to improve the health status of those members with chronic conditions, such as pediatric asthma and diabetes. This program includes member and practitioner education. The program's goal is to partner with the network providers to help members better self manage their health. Members may also receive phone calls from our health coaches every 60 to 90 days if they're at high or moderate risk for future health care utilization. If you think your patients may benefit from this program, please call 1-877-692-2059, Monday through Friday, 8 a.m. to 8 p.m. local time.
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