Quality Improvement

Your care means a lot to us. The purpose of the Quality Improvement Program is to ensure that we have 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 members

We work to improve the quality of care and service for you. We want you to be happy with the care and services you get. We use measurements to see how well we are doing. Some of the areas of care and service that we look at are:

• Preventive screenings
• Chronic disease management
• Care after being in a hospital for a behavioral health condition
• How quickly you get care and if you got the care you needed from your provider
• Care for children given ADHD medicines
• Care for substance use

We also ensure you get good service from us.

Preventive Health Guidelines

We use national preventive health guidelines to help you learn ways to stay healthy. These guidelines help you get the health screenings and exams that you need. Learn more about preventive care guidelines.

Get information about clinical practice guidelines and health information in member newsletters or by calling Member Services 1-844-607-2829 (TTY: 711).

We may also call or send you reminders for health exams and screenings you may need. If you have a long-term health issue like asthma or diabetes, you should:

• See your primary medical provider (PMP) on a routine basis.
• Talk with your PMP about the best plan to take care of your health issue or if you have trouble following your health plan.
• Take the medications your PMP has given you.
• Call your PMP to talk about changing the drugs if they make you sick or cause an allergic reaction.
• Don’t stop taking your medication until you talk to your PMP.