Quality Management

Opportunities for improvement and best practices are continuously pursued. A formal evaluation of the Quality Management program is continuously performed and documented annually. The Program itself focused on member-centric care and patient-provider relationships while evaluating data-driven decision making throughout the organization.

There are specific activities linked to the QM program which include:

• Provider accessibility and availability,
• Provider and member satisfaction,
• Grievance resolution,
• Department call center management,
• Improvement in HCC scores resulting in higher RAF scores; and
• Population management (detailed below).

Population health, including HEDIS® and STARs measure improvement is the cornerstone of the Quality Management program. Using our HEDIS® engine, Cozeva, our quality specialists boost HEDIS® scores, STARs rating and population health initiatives with data quality solutions and initiatives that standardize and extract value from data submitted by network providers and health plans.