Our Dedication to Quality

As a member, your health is our priority. The Quality Assessment and Performance Improvement (QAPI) program helps you get the care you need, to avoid preventable disease, manage chronic illnesses and disabilities, and maintain or improve health and quality of life. The program also looks for ways to make our services better.

QAPI Program Features

The QAPI program gives us a structure and guidelines for medical clinical care, behavioral clinical care, and other member services. It works to improve the quality of your health care and services.

The QAPI program helps members improve their health and wellness by:

  • Developing programs for members with special needs.
  • Offering programs that help members manage their health.
  • Arranging home visits and wellness events.
  • Making health education available to members.
  • Planning events to help you get care, find resources, and learn better ways to take care of you.

Our goal is to make sure health care and services our members receive are:

  • High quality
  • Safe
  • Right for the members' needs
  • Efficient
  • Effective

We review our QAPI program each year to see how we are doing. This review includes suggestions for improvement and setting goals for the next year.

Our mission is to help people get care, stay well, and build healthy communities. The Quality team supports this mission by checking on the health care and services members receive. We help with:

  • Health and disease management programs for members in a manner that meets the cultural and language needs of our members.
  • Outreach to members to help them get the care and health education they need.
  • Programs to serve our members who have special health care needs.
  • Continuity and coordination of care.
  • Member and provider surveys and using the responses to improve our services.
  • Reviewing the quality of care and services given by First Choice VIP Care Plus medical, behavioral health, and pharmacy providers.
  • Access to and availability of care and services.

QAPI Program Strengths and Accomplishments 2020-2022

Improvement noted in the following HEDIS® measures:

  • Controlling Blood Pressure
  • Diabetes Management: Blood Sugar Control and Nephropathy Monitoring
  • Care of Older Adults: Medication Review and Pain Assessment
  • Chronic Obstruction Pulmonary Disease Management: Pharmacotherapy Management and Spirometry Testing
  • Follow-up After Emergency Department Visit
  • Medication Reconciliation Post-Discharge

Enrollee Incentive Program

Administered an incentive program specific to annual flu vaccine.

Integrated QI Activities

Coordinated improvement interventions across a variety of departments including but not limited to Medical Management, Pharmacy, Community Outreach, Member Services, Compliance, Operations, and Provider Network.

CAHPS® Survey Results

The Plan performed above the national average on the following measures:

  • Getting Needed Care
  • Getting Appointments and Care Quickly
  • Rating of Health Care Quality
  • Customer Service
  • Care Coordination
  • Getting Needed Prescription Drugs
  • Rating of Drug Plan

Quality of Care (QOC) Reviews

We investigated, trended, and took action as necessary on all potential quality of care issues within established time frames.

Provider (PCP) Reports

Monthly profile reports are available on the provider portal to provide information on performance of measures for preventive care and chronic conditions. The measures selected provide valuable information to help improve the delivery of healthcare.

Reducing Health Care Disparities

We continue to collect and report member race, ethnicity, and language data needed to address and decrease disparities in health care. We also ensure all member mailings include appropriate translation instructions and monitor member utilization of the language line.

QAPI Program Priorities and Goals

In 2024, we will remain committed to a seamless enrollee experience with adequate access to high quality, coordinated care and services with the goal to decrease the burden of disease and improve health outcomes. We will prioritize improving the health of our members and reducing health care disparities with our continuing efforts to:

  • Improve performance measures through:
    • Monitoring access to care and services, including promotion of telehealth options.
    • Monitoring compliance with prescribed health screenings.
    • Enhancing chronic disease management.
    • Expanded member and provider outreach initiatives to improve utilization of services
  • Strengthen our processes to address care gaps, including:
    • Maintaining effective care management and Long-Term Services and Supports programs.
    • Improving communication among the Plan and medical and behavioral health providers to ensure effective coordination of care.
    • Focusing on preventive care and early identification, including immunizations and cancer screenings.
    • Ensuring effective medication adherence and transitions of care programs.
    • Reviewing and updating evidence-based clinical practice guidelines to promote implementation of comprehensive medical and health care practices, including preventive, diagnostic and treatment services.
  • Expand efforts to assist and empower members to manage and improve their health in collaboration with their health care providers.
  • Improve member safety through ongoing monitoring and investigation of potential quality of care issues.