Quality Improvement
Our Quality Improvement Department strives to provide products and services of the highest quality and value with a direct focus on meeting the needs of the customer. Through monitoring and evaluation, we can work together to benefit both members and health care providers.
To assist our providers, we also provide Quality Improvement HEDIS® Tip Sheets. These measures from the National Committee for Quality Assurance (NCQA) help ensure our members receive appropriate care.
HEDIS Tip Sheets
- Adult Access to Preventive/Ambulatory Health Services
- Appropriate Testing for Pharyngitis
- Appropriate Treatment for Upper Respiratory Infection
- Avoidance of Antibiotic Treatment for Acute Bronchitis
- Breast Cancer Screening
- Cervical Cancer Screening
- Child and Adolescent Well-Care Visits
- Child and Adolescent Measures
- Childhood Immunization Status
- Children and Adolescents’ Access to Primary Care Practitioners HEDIS® Tip Sheet
- Chlamydia Screening in Women
- Colorectal Cancer Screening
- Comprehensive Diabetes Care
- Comprehensive Diabetes Care – Retinal Eye Exam
- Comprehensive Diabetes Care – Nephropathy
- Controlling High Blood Pressure
- Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis
- Follow-Up After Emergency Department Visit for People with High-Risk Multiple Chronic Conditions
- Kidney Health Evaluation for Patients with Diabetes
- Medication Management for People with Asthma
- Metabolic Monitoring for Children and Adolescents on Antipsychotics
- Osteoporosis Management in Women Who Had a Fracture
- Pharmacotherapy Management of COPD Exacerbation
- Plan All-Cause Readmissions
- Prenatal and Postpartum Care
- Statin Therapy for Patients with Cardiovascular Disease
- Use of Imaging Studies for Low Back Pain
- Use of Opioids from Multiple Providers
- Use of Spirometry Testing in the Assessment and Diagnosis of COPD
- Women’s Health Tip Sheet
Behavioral Health HEDIS Tip Sheets
- Antidepressant Medication Management (AMM)
- Diabetes Screening for Members Taking Antipsychotics (SSD)
- Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA)
- Follow-Up After Emergency Department Visit for Mental Illness (FUM)
- Follow-Up after Hospitalization for Mental Illness (FUH)
- Follow-Up Care for Children Prescribed ADHD Medication (ADD)
- Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)
- Treatment for Alcohol and Other Drugs (IET)
- Use of Opioids from Multiple Providers (UOP)
