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Quality

The Quality Improvement Program includes initiatives to ensure that members are receiving age-appropriate preventive health screenings and interventions to optimize health.

The information on this page provides useful information and tools for managing patient care based on industry-standard clinical practice guidelines.

    Preventive Depression Screening Program

    The Depression Prevention program promotes collaboration, continuity and coordination between medical and behavioral health care.

    New: HEDIS Measurement Year 2024 Toolkit

    HEDIS® Measurement Year Adult Pocket Guide 2024

    HEDIS® Measurement Year Adult Pocket Guide 2024

    HEDIS Measurement Year 2023 Toolkit

    HEDIS® Measurement Year Adult Pocket Guide 2023

    HEDIS® Measurement Year Adult Pocket Guide 2023

    HEDIS® At-a-Glance STARS Measures

    Quality Measures

    Social determinants influence health in very direct ways. A patient’s housing, food, and safety needs can create barriers blocking quality care and can contribute to poor health.

    Controlling Blood Pressure Flyer

    OMW – Osteoporosis Management Flyer

    Use this tip sheet for best practices on how to talk to your patients about why they need to maintain adherence and how to track their medications.

    Examples of Centers for Medicare and Medicaid Services Star measures which use statin therapy to evaluate health plans.

    Medicare Incentive Programs

    Unlock the Benefits of Partnership!

    Primary care providers have the opportunity to earn a bonus by addressing preventive care and closing care gaps.

    Additional Quality Documents

    Supplemental Data is any data used in HEDIS® rate calculation that is not submitted through claims processing or HEDIS® Hybrid manual medical record review. Supplemental data captures discrete events and procedures that occur during patient encounters, complementing data obtained through claims.

    Implementation Guide: Version 1.0

    CAHPS and HOS Resources

    CAHPS (Consumer Assessment of Healthcare Providers and Systems) Resource Guide

    Consumer Assessment of Healthcare Providers and Systems (CAHPS) is a survey tool that asks patients to evaluate their experience with their health plan and at providers’ offices.

    HOS Health Outcomes Survey

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    Last Updated On: 10/17/2024