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The Quality Management (QM) Department identifies
opportunities for improvement of care and services to both our members
and providers. This is accomplished by assisting with the identification,
investigation, implementation, and evaluation of corrective actions
that continuously improve and measure the quality of clinical and
administrative service. This Quality Management Program covers all
lines of business, including but not limited to, Medi-Cal and Healthy
Families. A formal evaluation of the Quality Management functions
is performed annually.
Focus Area
Specific key elements of focus for the Quality Management Department
may include but are not limited to:
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Provider accessibility and availability |
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Provider satisfaction |
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Provider Credentialing |
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Clinical practice guidelines |
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Under and over utilization |
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Adverse outcomes/sentinel events |
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Medical record keeping practices |
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Facility site reviews |
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Member satisfaction/grievances |
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Timeliness of handling claims |
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High risk and high volume services |
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Oversight of IPA QM function |
The Quality Management Program is designed to objectively
and systematically monitor and evaluate the quality, appropriateness
and outcome of care and services delivered to our members and to
provide mechanisms that continuously pursue opportunities for improvement
and problem resolution.
What is the Healthy
Start Program?
The Healthy Start Program is a comprehensive prenatal and
postpartum program designed to focus on early identification of pregnant
women, assist with immediate access to care issues, and provide education
to our pregnant members to ensure they understand and are able to
perform self-care aspects of pregnancy. Read more
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