Quality Improvement

Program Purpose

CareSource is committed to providing evidence-based care in a safe, member-centered, timely, efficient and equitable manner. The scope of the CareSource Quality Management and Improvement Program (QMIP) is comprehensive, inclusive of both clinical and non-clinical services, and health, safety and welfare concerns. CareSource monitors and evaluates the quality and safety of the care and service delivered to our members, emphasizing:

  • Accessibility to care
  • Availability of services and practitioners
  • Medical and behavioral health services
  • Internal monitoring, review and evaluation of program areas, including utilization management, disease management, care management and pharmacy

Member and provider satisfaction and health outcomes are monitored through:

  • Quality improvement activities
  • Routine health plan reporting
  • Annual Health Effectiveness Data and Information Set (HEDIS) – measures the quality of our health plan
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS) – measures patient experience with the health care system
  • Member surveys
  • Provider surveys
  • Review of accessibility and availability standards
  • Utilization trends

CareSource assesses our performance against goals and objectives that align with industry standards. Annually, we complete an evaluation of our QMIP.

CareSource maintains accreditation by the National Committee for Quality Assurance (NCQA).

The purpose of the CareSource Quality Management and Improvement Program (QMIP) is to ensure that CareSource Indiana has the necessary infrastructure to:

  • Coordinate member care and services to improve health outcomes
  • Promote the use of evidence-based best practice for the treatment of member health conditions
  • Ensure high-performing and efficient systems for delivery of care
  • Address the health, safety and welfare concerns of CareSource members and implement appropriate interventions.

The QMIP is revised as needed:

  • To remain responsive to member needs
  • Based on feedback received from our providers and other health partners
  • In response to changes in nationally recognized practice standards and evidence-based research
  • To meet CareSource business needs

Contact Us

If you would like more information about CareSource Quality Improvement, please call Provider Services, Monday through Friday, 8 a.m. to 8 p.m. Eastern Time (ET) at 1-844-607-2831.

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).