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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

    This program promotes collaboration, continuity and coordination between medical and behavioral health care.

    Million Hearts Action Guide 
    The Hypertension Control: Change Package for Clinicians  is a quality improvement tool for ambulatory clinical settings to improve hypertension control. This guide includes change concepts, change ideas, and evidence or practice based tools and resources.

    2019 HEDIS Toolkit

    This form is to assess care needs for older adults.

    The survey is used to measure how the care provided by Medicare Advantage Organizations (MAO) affects the health outcomes of their enrollees.

    Medication Reconciliation Post-Discharge (MRP): This HEDIS measure ensures that members who are discharged from the hospital have their medications reviewed by a prescribing practitioner, clinical pharmacist or registered nurse within 30 days of discharge. An outpatient visit is not required, but is highly encouraged.

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

    2018 HEDIS Toolkit

    HEDIS® ensures health plans are offering quality preventive care and service to members. It also allows for a true comparison of the performance of health plans by consumers and employers.

    2018 HEDIS At-A-Glance Key Adult Measures

    This document details the importance of coordination of care.

    HEDIS Guide Adult Quick Tips

    At WellCare, we value everything you do to deliver quality care for our members – your patients – to make sure they have a positive health care experience. That’s why we’ve created this easy-to-use, informative HEDIS® At-A-Glance Guide. It gives you the tools you need to meet, document and code HEDIS Measures.

    At WellCare, we value everything you do to deliver quality care for our members – your patients – to make sure they have a positive health care experience. That’s why we’ve created this easy-to-use, informative HEDIS® At-A-Glance Guide. It gives you the tools you need to meet, document and code HEDIS Measures.

    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?

    The survey is used to measure how the care provided by Medicare Advantage Organizations (MAO) affects the health outcomes of their enrollees.

    Medication Reconciliation Post-Discharge (MRP): This HEDIS measure ensures that members who are discharged from the hospital have their medications reviewed by a prescribing practitioner, clinical pharmacist or registered nurse within 30 days of discharge. An outpatient visit is not required, but is highly encouraged.

    2018 HEDIS At-a-Glance Key Pediatric Measures

    HEDIS Guide Pediatric Quick Tips

    HEDIS reference guide for Pediatric care.

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

    Other Resources

    WellCare shall monitor providers against the following standards to ensure members can obtain needed health services within the acceptable appointment time frames, in-office waiting times, and after-hours standards.

    New York Confidential Case Report Form

    Promoting cultural and linguistic competency self-assessment checklist for personnel providing primary health care services

    A form used to order copies of the New York State Health Care Proxy

    The documentation standards listed here applies to all medical records

    The documentation listed here applies to all obstetrical records

    This tool is designed to be a working record for all WellCare members.

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    Last Updated On: 8/6/2018