Quality Improvement

Quality Improvement Program

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 always 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 for conditions such as:
  • Asthma
  • Diabetes
  • High blood pressure
• Care after being in a hospital for a behavioral health condition

We also look at how quickly you get care and if you got the care you needed from your PCP. We also check to 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 the preventive care guidelines.

Get information about clinical practice guidelines and health information in our member newsletters or by calling Member Services. 

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 PCP on a routine basis.
• Talk with your PCP about the best plan to take care of your health issue or if you have trouble following your health plan.
• Take the medications your PCP has given you.
• Call your doctor 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 doctor.

Questions? Call Member Services at 1-833-230-2057 (TTY: 1-833-711-4711 or 711). We are open seven days a week, 8 a.m. to 8 p.m. Eastern Time.