First Choice VIP Care Plus is committed to high-quality and coordinated health care services that meet enrollees’ needs and improve health outcomes. We have created a Quality Assessment and Performance Improvement (QAPI) program to support this goal. The QAPI program aims to help enrollees get effective, appropriate, and safe care, 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 and Scope

The QAPI program provides a structure and guidelines for medical and behavioral health care and non-clinical services available to our enrollees. It utilizes a continuous cycle for assessing the quality of care and services to promote improvement. Coordinated improvement interventions occur in an integrated manner across a variety of departments, including but not limited to Medical Management, Pharmacy, Community Outreach, Member Services, Operations, Provider Network Management, Utilization Management, and Compliance. We evaluate our QAPI program each year.  

The mission of First Choice VIP Care Plus is to help people get care, stay well, and build healthy communities. The QAPI program supports this mission through the following:

• Leveraging health and disease management and education programs for enrollees that help them manage their health in a manner that meets their cultural and language needs and preferences.
• Outreach to enrollees using various methods to help them get the care and health education they need.
• Programs to serve our enrollees who have special health care needs.
• Ensuring continuity and coordination of care.
• Collaboration with providers, community agencies, and regulatory agencies.
• Enrollee and provider surveys, and using the responses to improve our services.
• Reviewing quality of care concerns.
• Ensuring access to and availability of care and services.
• Continually assess the characteristics and needs of our enrollees, including social determinants of health.
• Determine provider adherence to Clinical Practice Guidelines. 

QAPI Program Strengths and Accomplishments 2024

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

Improvement noted in the following:

• Care for Older Adults (COA): Medication Review, Pain and Functional Assessments
• Colorectal Cancer Screening (COL)
• Controlling High Blood Pressure (CBP)
• Kidney Health Evaluation for Patients with Diabetes (KED)
• Eye Exam for Patients With Diabetes (EED)
• Transitions of Care-Medication Reconciliation Post-Discharge (TRC-MRP)
• Patient Engagement post discharge (TRC-patient engagement)

CAHPS^® Survey Results

Improvement noted in the following CAHPS measures:

• Getting needed care
• Getting appointments and care quickly
• Doctors who communicate well
• Rating of health plan
• Rating of health care quality

Goals Met/Improvement Noted

• Improving appropriate utilization of services
• Improving access to essential services
• Improving coordination of care
• Improving access to preventive health services
• Improving health outcomes
• Improving seamless transitions of care 

Reducing Health Care Disparities

A Health Equity and Culturally and Linguistically Appropriate Services (HECLAS) Committee was implemented in 2024. The plan continued to collect and report enrollee race, ethnicity, and language data needed to address and decrease disparities in health care. The plan also ensured all enrollee mailings included appropriate translation instructions.

QAPI Program Priorities and Goals

In 2024, we remained 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 prioritized improving the health of our enrollees 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 enrollees’ compliance with health screenings and providers’ adherence to evidence-based Clinical Practice Guidelines.
  • Implementing programs to increase preventive health services.
  • Enhancing chronic disease management.
  • Expanding enrollee and provider outreach initiatives.
• Strengthen our processes to address care gaps, including:
  • Maintaining effective care management.
  •  Improving coordination and transition of care processes.
  • Improving communication and collaboration with providers.
  • Focusing on preventive care and early identification, including immunizations and cancer screenings.
  • Ensuring effective medication adherence and transitions of care programs.
• Continue to identify healthcare disparities and develop programs and activities to address barriers that contribute to the disparities.
• Improve enrollee safety through ongoing monitoring and investigation of potential quality of care issues.

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