Quality Improvement

Quality Improvement

The Quality Improvement (QI) 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 Improvement Program covers all lines of business, including but not limited to, Medi-Cal, Medicare and Healthy Families. A formal evaluation of the Quality Improvement functions is performed annually.

Focus Area

Specific key elements of focus for the Quality Improvement Department may include but are not limited to:

  • Provider accessibility and availability
  • Provider satisfaction
  • Provider credentialing
  • Clinical practice guidelines
  • Under and over utilization
  • Adverse outcomes/sentinel events
  • Medical record keeping practices
  • Facility site reviews
  • Member satisfaction/grievances
  • Timeliness of handling claims
  • High risk and high volume services
  • Oversight of IPA QM function

The Quality Improvement 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.

Annual Evaluations/ Program Goals:

Click here to view full Quality Improvement Executive Summary (Goals/Achievements)

Provider Notifications/Updates (NCQA )

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.

Initial Health Assessment (IHA)

All Medi-Cal members should receive timely access to an IHA within 120 days of enrollment regardless of age.

More on Quality Improvement

Access to Care Standards, Provider Survey Results, Survey Results (CAHPS®), Study Results (HEDIS®), Care1st CARES Programs... Click here!