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Quality

'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.


New: HEDIS Measurement Year 2020 Toolkit

2021HEDIS®

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

2021HEDIS®

2021HEDIS®

2021HEDIS®

This guide alerts you to important preventive care and services that you can provide to patients to help boost Star Ratings.

2021HEDIS®

2021HEDIS®

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: 12/17/2020