Making sure you get quality care

We want to make sure you receive safe and effective health care services. That's why our Quality Improvement Program sets standards for the quality of the health care you get. We monitor and analyze how health care is delivered and how well we provide services to you. We use what we learn to improve the delivery of health care services and help our members live healthier lives.

Our standards require that the care you get is:

  • Accessible
  • Safe
  • Patient-centered
  • Reliable
  • Timely
  • Efficient
  • Cost effective
  • Proven to promote and improve health

We monitor health care quality in several areas, including:

  • Patient safety
  • How effective your health care is at making and keeping you healthy
  • How well your doctors coordinate your care among themselves and with us
  • How well we, and your doctors, manage your medications
  • Your access to and the availability of doctors and other health care services
  • Customer satisfaction, including the resolution of grievances and appeals
  • Our compliance with state, national and federal guidelines and requirements
  • How well we help you manage chronic diseases, including services and education provided to you and your doctors
  • The speed and helpfulness of our customer service, including claims processing and telephone contact

Our committees help us meet our standards and improve your health care

Our Quality Integration committee meets every two months to make policy decisions and evaluate the quality improvement efforts of our many clinical and service quality committees. Committee members include our chief executive officer, chief medical officer, associate vice president of clinical programs, physicians, employers, union representatives and members of our board of directors.

We're committed to continuous improvement

Each January we develop a quality improvement work plan for the year. The plan identifies areas in which we want to improve, monthly schedules for our improvement activities, and those who are responsible for making sure improvements occur.