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Quality

Overview

‘Ohana Health Plan’s Quality Improvement (QI) Program monitors and evaluates the quality, appropriateness, accessibility and availability of health care services.

Medical Records

QI may conduct annual medical record audits in physician offices. Patient records are reviewed for evidence that care and screenings have been documented. Complete information is available in the Medicaid  or Medicare Advantage provider manuals.

Clinical Practice Guidelines

CPGs outline medical standards of care and best practices.

HEDIS®*

HEDIS® is a mandatory process that occurs annually. We've developed this toolkit to help identify required preventive services.


2019 HEDIS Toolkit

HEDIS® (Healthcare Effectiveness Data and Information Set)

2019 HEDIS® AT-A-GLANCE: KEY ADULT MEASURES

Coordination of Care requires proactively identifying the patient’s needs, organizing care and communicating vital information at the right time to the right people.

HEDIS® Guide Adult Quick Tips

HEDIS® Adult Resource Guide

2019 HEDIS® AT-A-GLANCE: KEY BEHAVIORAL MEASURES (18 Years and Older)

This form is to assess care needs for older adults.

Every year CMS or NCQA may ask your patient the following questions. How do you rate?

We’re asking our providers to make sure to use accurate CPT Category II codes to improve efficiencies in closing patient care gaps and in data collection for performance measurement.

2019 HEDIS® AT-A-GLANCE: KEY PEDIATRIC MEASURES

Pediatric and Behavioral Health Measures

What are your patients saying about the care they received? Each year, a child CAHPS survey is conducted to collect information about patient healthcare experience. Studies show patients who are happy with their personal doctor are more compliant to treatment plans and have better health outcomes.

Preventive Health Counseling and Education for Children and Adolescents Ages 3–17 Years

HEDIS® Guide Pediatric Quick Tips

2018 HEDIS Toolkits

HEDIS ensures health plans are offering quality preventive care and service to members.

2018 HEDIS At-a-Glance Key Adult Measures

This document details the importance of coordination of care.

Important information for Medicare providers.

2018 HEDIS At-a-Glance Key Behavioral Measures (17 Years and Younger)

Information concerning the mental and emotional well-being of patients.

Every year CMS or NCQA may ask your patient the following questions. How do you rate?

2018 HEDIS At-a-Glance Key Pediatric Measures

A HEDIS quick reference guide for pediatric care

HEDIS reference guide for Pediatric care.

How to Code for a Well Visit with a Sick Visit

Preventive Health Counseling and Education for Children and Adolescents (Ages 3-17 Years)

Other Resources

These questions below were developed to determine whether a tuberculin skin test is indicated.

Helpful Information

EPSDT Program

Sign in to our secure Provider Portal to find out which eligible members are due for EPSDT screenings. If you haven’t registered on our site, please join today. Preventive pediatric health care guidelines for children are located in our clinical practice guidelines.

Provider Participation

Network providers are contractually required to cooperate with quality improvement activities. Providers are also invited to volunteer for the QI Program. Please contact us if you’re interested in volunteering.
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Last Updated On: 8/6/2018
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