Quality Improvement

We want you to be happy with the care and services you get. We monitor some areas of care and service to be sure that you get high quality care. These include:

  • Well-child care
  • Preventive screenings
  • Prenatal and postpartum care
  • Chronic disease management for conditions such as:
    • Asthma
    • Diabetes
    • High blood pressure
  • Care after being in a hospital for a behavioral health condition
  • Care for children given ADHD medicines

We monitor how quickly our members get care and if they got the care they needed from their PCP. We also check to ensure our members get quality service from CareSource.

Clinical Practice Guidelines: Member Health Information

We use national clinical practice health guidelines and other information to help you learn how to take care of long-term and common health conditions, like asthma or diabetes. Learn more at Health Care Links page. To learn more about preventive health screenings for men and women visit preventive care guidelines.

CareSource may also call or send you information about health care checkups and screenings you may need. If you have a long-term (chronic) condition, be sure to:

  • See your PCP or other health care provider regularly.
  • Follow the treatment plan given by your provider.
  • Take your medicines correctly.
  • Follow guidance for testing. For example, taking your blood sugar and blood pressure.

You can call the CareSource24® number on your member ID card 24/7/365 to talk with a registered nurse. Get more information about the CareSource Quality Improvement program visit the web page, consult your Member Handbook or call Member Services.

We want you to have the best health care available.


Our performance, quality, and health outcomes are collected, looked at, and reported to evaluate the care you receive.

Our Quality Department reviews these measures:

  • Healthcare Effectiveness Data and Information Set (HEDIS) to measure performance on dimensions of care and service
  • Health Outcomes Survey (HOS) to assess patient reported outcomes
  • Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to measure member satisfaction
  • Other experience and health outcome surveys
  • Any Centers for Medicare & Medicaid Services (CMS) standards for quality and safety
  • Clinical service quality improvement projects
  • Chronic Care Improvement Programs (CCIP) that identify eligible members and interventions to improve disease management

Performance Evaluation

After performance and quality data is collected, an evaluation is conducted that covers these areas:

  • Improving access and affordability of healthcare
  • Improving coordination of care and delivery of services
  • Improving transitions of care across health care settings
  • Ensuring appropriate utilization of services for preventive health and chronic conditions
  • Ensuring you receive high quality and safe health care