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Quality Assessment and Performance Improvement program

As a member, your health is our first priority. That’s why we have a Quality Assessment and Performance Improvement (QAPI) program. The QAPI program looks for ways to make our services better. That can make it easier for you to stay healthy.

QAPI program features

The QAPI program works to improve the quality of your health care. It gives us a structure and guidelines for medical clinical care, behavioral clinical care, and other member services.

The quality improvement program looks for ways to make our services better by:

  • Using surveys to get feedback from members and providers.
  • Getting information from medical and service area studies.
  • Talking to providers to find ways to make our services better.
  • Checking that we reach our service goals each year.

The program also helps our members improve their health and wellness by:

  • Developing programs for members with special needs.
  • Offering programs that help members manage their health.
  • Arranging home visits and wellness events with our Community Educators and Community Care Management team.
  • Making health education available to members.
  • Planning events to help you get care, find resources and learn better ways to take care of you and your family.

What we’ve done so far

When we make health care better, everyone benefits. Members can get better health outcomes. Providers can give care to more people, more efficiently.

Here are a few of the things we’ve done so far.

Improving health care quality and efficiency

We earned accreditation from the National Committee for Quality Assurance (NCQA). The NCQA is a group that surveys and certifies health care plans for high quality.

We also improved our score on the 2017 Healthcare Effectiveness Data and Information Set (HEDIS®). HEDIS is a tool that measures health plans’ care and service.

Improvement and goals were met in the following areas:

HEDIS Measure 2017 Results Goal Was Goal Met
Diabetic HbA1C Testing 86.86% 84.84% Yes
Diabetic Eye Exams 53.77% 53.28% Yes
Cervical Cancer Screenings 61.54% 55.94% Yes
Well Child Visits, 3-6 Years 62.76% 62.27% Yes
Lead Screening in Children 73.72% 71.05% Yes

 

We were ranked as one of the top Medicaid plans in Louisiana, by the National Committee for Quality Assurance (NCQA)

Supporting our members and providers

Health care is a group effort. We work hard to support our members and providers.

We added associates to help providers work with members with special health care needs. We also improved our results for our adult and child Consumer Assessment of Healthcare Providers and Systems (CAHPS) member satisfaction survey and provider satisfaction survey.

For the CAHPS survey, the Plan improved the Rating of Health Plan for both the Adult and Child surveys.

Providing training and education

Education is important in health care. It gives our providers and associates the tools they need to help you. That’s why it's so important to get them the education they need.
We taught our providers how to use our online tools. We also showed them how to use the services we have as a health plan. That means it’s easier for providers to get you the care you need.
It’s also important to talk to you in a way that fits your culture and language. That’s why we trained our staff and providers in cultural competency and health literacy. We’ve also made the Member Handbook and other materials available in multiple languages.

What we’ve got planned for the future

Quality improvement never stops! We are always looking for new ways to make your health care even better.

Here are a few things we’re working on now:

  • Using data and member education to reduce emergency room use for conditions that are not emergencies.
  • Teaching members about preventive care. We also teach members about how important it is to see their primary care providers for a well check at least once a year.
  • Helping members with diabetes stay on track. Members can reduce some of the problems from diabetes by staying on top of blood sugar levels. It is also important to get screenings like the HbA1C check and a diabetic eye exam at least once a year.
  • Working to improve member satisfaction, as measured by overall satisfaction scores.
  • Using education to reduce health care gaps related to race, ethnicity, and language.
  • Conducting a language review of provider and member groups to make sure our doctors meet the language needs of our members.
  • Teaching providers about health literacy.
  • We’re working with providers to improve after-hours phone call response time and specialist appointment availability.
  • Maintain our NCQA accreditation status in 2018.

Do you have questions?

Contact Member Services, 24 hours a day, at 1-888-756-0004 (TTY 1-866-428-7588) to learn more about our Quality program.