Quality Improvement Program
Your care means a lot to us. The purpose of the CareSource Georgia Quality Management and Improvement program is to ensure that CareSource Georgia has the resources needed to:
- Coordinate care
- Promote quality
- Ensure performance and efficiency on an ongoing basis
- Improve the quality and safety of clinical care and services provided to CareSource members
CareSource Georgia continually assesses and analyzes the quality of care and services offered to our members. This is accomplished by using objective and systematic monitoring and evaluation to implement programs to improve outcomes.
CareSource uses HEDIS to measure the quality of care delivered to members. HEDIS is one of the most widely used means of health care measurement in the United States. HEDIS is developed and maintained by the NCQA. HEDIS is used by America’s health plans to measure important dimensions of care and service and allows for comparisons across health plans in meeting state and federal performance measures and national HEDIS benchmarks. HEDIS measures are based on evidence-based care and address the most pressing areas of care. Potential quality measures are:
- Wellness and prevention
- Preventive screenings (breast cancer, cervical cancer, chlamydia)
- Well-child care
- Chronic disease management
- Comprehensive diabetes care
- Controlling high blood pressure
- Behavioral health
- Follow-up after hospitalization for mental illness
- Antidepressant medication management
- Follow-up for children prescribed ADHD medication
- Use of imaging studies for low back pain
CareSource also uses the annual member survey, CAHPS surveys, to capture member perspectives on health care quality. CAHPS is a program overseen by the United States Department of Health and Human Services ―Agency for Healthcare Research and Quality (AHRQ). Potential CAHPS measures include:
- Customer service
- Getting care quickly
- Getting needed care
- How well doctors communicate
- Ratings of all health care, health plan, personal doctor, specialist
Preventive Guidelines and Clinical Practice Guidelines
CareSource approves and adopts nationally accepted standards and guidelines to help inform and guide the clinical care provided to CareSource Georgia members. Guidelines are reviewed and approved by the CareSource Clinical Advisory Committee at least every two years or more often as appropriate, and updated as necessary. The guidelines are then presented to the CareSource Quality Enterprise Committee. The use of these guidelines allows CareSource to measure the impact of the guidelines on outcomes of care. Topics for guidelines are identified through analysis of CareSource Georgia members. Guidelines may include, but are not be limited to:
- Preventive health
- Behavioral health (e.g., depression, ADHD, substance use disorder)
- Chronic condition management (e.g., hypertension, diabetes, cardiovascular disease, cerebrovascular disease and chronic obstructive pulmonary disease)
- Population health (e.g., obesity, tobacco cessation)
Information about clinical practice guidelines and health information are made available to CareSource Georgia members via member newsletters, this website or upon request. Preventive Guidelines and Health Links are available to members and providers via the website or hard copy.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
Member Services: 1-855-202-0729 (TTY: 1-800-255-0056 or 711), Monday – Friday 7 a.m. – 7 p.m.