Quality Improvement Program

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

Quality Metrics

We continually assess and analyze the quality of care and services offered to our members. This is done using objective and systematic monitoring and evaluation to implement programs to improve outcomes.

CareSource uses HEDIS to measure the quality of care given to members. HEDIS is one of the most widely used means of health care measurement in the United States. HEDIS measures important dimensions of care and service. It compares health plans by how well they meet state and federal performance measures and national HEDIS benchmarks. HEDIS measures are evidence-based and address the most pressing areas of care. Potential quality measures are:

  • Wellness and prevention
  • Flu shots
  • 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
  • Safety
  • Use of imaging studies for low back pain

CareSource also uses CAHPS surveys to get member perspectives on health care quality. CAHPS is a program overseen by the U.S. Department of Health and Human Services. Potential CAHPS measures include:

  • Customer service
  • Getting care quickly
  • Getting needed care
  • How well doctors communicate
  • Ratings of all health care, health plans, personal doctors and specialists

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 members. These guidelines allow CareSource to measure the impact of the guidelines on outcomes of care. Topics for guidelines are identified through analysis of CareSource members. Guidelines may include, but are not 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 through member newsletters or by calling Member Services. 

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Member Services: 1-800-488-0134 (TTY: 1-800-750-0750 or 711), Monday – Friday 7 a.m. – 7 p.m.