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Quality Assessment and Performance Improvement (QAPI) Program

The mission of AmeriHealth Caritas Louisiana is to help people get care, stay well and build healthy communities. We have a robust QAPI program that looks for ways to improve a member's health.

QAPI program features

The QAPI program uses an integrated, comprehensive approach to improvement. The process involves personnel from our Quality Management, Medical Management, Provider Network Management, Compliance, and Customer Services departments. The QAPI program:

  • Looks for areas that need to be improved in medical and preventive services.
  • Offers disease and health programs.
  • Provides outreach to members and gives health education.
  • Performs medical and service area studies when they are needed.
  • Monitors the quality of care and services given by AmeriHealth Caritas Louisiana providers, such as medical, behavioral, dental, vision, and pharmacy services.
  • Creates programs for members with special health care needs.
  • Works with providers to identify ways to improve our services.
  • Surveys members and providers, and uses the answers to improve our services.
  • Is monitored and evaluated annually to make sure the plan is meeting its service and clinical improvement goals.

Recent accomplishments

  • Achieved “First” Accreditation status from the National Committee for Quality Assurance (NCQA), and will undergo the “Renewal” survey in early 2018. This demonstrates that the plan’s programs for service and clinical quality are well established and meet rigorous requirements for consumer protection and quality improvement.
  • Implemented collaborative efforts across the plan and interventions to improve the plan’s incentive based Healthcare Effectiveness Data and Information Set (HEDIS®) results.
  • Developed performance improvement projects for all HEDIS measures that scored below the Quality Compass 25th percentile. This will aid in identifying barriers and interventions for improving the plans HEDIS rates.
  • Ranked as one of the top Medicaid plans in Louisiana, by the NCQA.
  • Successfully integrated behavioral health care services into the plan’s benefit structure.
  • Continued development and promotion of care gap identification capabilities for providers.
  • Educated providers on the information that can be obtained through the NaviNet provider portal and facilitated hands-on provider training.
  • Implemented targeted site visits to providers by the medical director and provider network staff to educate on services we offer (such as case management and interpretation services) and tools to assist with overall HEDIS rates.
  • Successfully completed annual medical record review to measure provider compliance with plan standards for medical record documentation.
  • Developed and executed Culturally and Linguistically Appropriate Services (CLAS) interventions for Member Advisory Council groups. Also distributed Spanish-language materials to community organizations. Distributed the member newsletter in Spanish.
  • Conducted annual staff training to improve knowledge on cultural competency and health literacy.
  • Earned NCQA’s Multicultural Health Care Distinction: This distinction is offered to organizations that engage in efforts to improve culturally and linguistically appropriate services, as well as reduce health care disparities.

Future goals

  • Maintain NCQA accreditation status — our renewal survey is in early 2018.
  • Continue to utilize data to reduce emergency room use for conditions that are not emergencies.
  • Strengthen outreach initiatives, while developing new opportunities for identified clinical incentive based HEDIS measures as well as all HEDIS measures that scored below the Quality Compass 25th percentile.
  • Continue ongoing development of initiatives that promote the use of Navinet for identification of clinical care gaps to providers.
  • Implement processes and strategies to improve HEDIS scores and Consumer Assessment of Healthcare Providers and Systems® survey results, focusing on areas identified as needing improvement.
  • Improve provider and the plan’s (staff) knowledge of HEDIS, and the importance of improving member and provider compliance with clinical care guidelines through the development of provider and staff education materials and/or presentations.
  • Identify and prioritize opportunities to reduce health care disparities (race, ethnicity, and language).
  • Look at any disparities based on a HEDIS performance measure. Reduce the disparity by implementing a targeted, culturally competent intervention.

Questions?

For additional information or questions, please contact a Provider Services representative at 1-888-922-0007.