Quality Management

Opportunities for improvement and best practices are continuously pursued. A formal evaluation of the Quality Management program is continuously performed and documented annually. The Program itself focused on member-centric care and patient-provider relationships while evaluating data-driven decision making throughout the organization. There are specific activities linked to the QM program which include: - Provider accessibility and availability, - Provider and member satisfaction, - Grievance resolution, - Department call center management, - Improvement in HCC scores resulting in higher RAF scores; and - Population management (detailed below). Population health, including HEDIS® and STARs measure improvement is the cornerstone of the Quality Management program. Using our HEDIS® engine, Cozeva, our quality specialists boost HEDIS® scores, STARs rating and population health initiatives with data quality solutions and initiatives that standardize and extract value from data submitted by network providers and health plans.