Our Dedication to Quality

As a member, your health is our priority. The Quality Assessment Performance Improvement (QAPI) program helps you get the care you need, to avoid preventable disease, manage chronic illnesses and disabilities, and maintain or improve health and quality of life. The program also looks for ways to make our services better.    

QAPI program features

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

The QAPI program helps 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
• Making health education available to members
• Planning events to help you get care, find resources, and learn better ways to take care of you

Our goal is to make sure health care and services our members receive are:

• High quality
• Safe
• Right for the members' needs
• Efficient
• Effective

We review our QAPI program each year to see how we are doing. This review includes suggestions for improvement and setting goals for the next year.

Our mission is to help people get care, stay well, and build healthy communities. The Quality team supports this mission by checking on the health care and services members receive. We help with:

• Health and disease management programs for members in a manner that meets the cultural and language needs of our members
• Outreach to members to help them get the care and health education they need
• Programs to serve our members who have special health care needs
• Continuity and coordination of care
• Member and provider surveys and using the responses to improve our services
• Reviewing the quality of care and services given by AmeriHealth Caritas VIP Care Plus medical, dental, vision, and pharmacy providers
• Access to and availability of care and services

QAPI program strengths and accomplishments 2024-2022

Improvement noted in the following HEDIS measures:

• Anti-Depressant Medication Management
• Care of Older Adults
• Controlling Blood Pressure
• Diabetes Management: Blood sugar testing and control
• Medication Reconciliation Post-Discharge
• Statin Therapy in Patients with Cardiovascular Disease

Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey

Improvement noted in the following measures:

• Getting Needed Care, Tests, or Treatments
• Doctors Communicate/Follow Up with Test Results
• Health Care Quality
• Getting Needed Drugs composite 

Integrated QI Activities

Coordinated improvement interventions across a variety of departments including but not limited to Medical Management, Pharmacy, Credentialing, Member Services, Compliance, Operations, and Provider Network.

Enrollee Incentive Program

Administered an incentive program specific to annual flu vaccine.

Integrated QI Activities

Coordinated improvement interventions across a variety of departments including but not limited to Medical Management, Pharmacy, Community Outreach, Member Services, Compliance, Operations, and Provider Network.

Quality of Care (QOC) Reviews

We investigated, trended, and took action as necessary on all potential quality of care issues within established time frames.

Provider (PCP) Reports: Monthly profile reports are available on the provider portal to provide information on performance of measures for preventive care and chronic conditions. The measures selected provide valuable information to help improve the delivery of health care.

Reducing Health Care Disparities

We continue to collect and report member race, ethnicity, and language data needed to address and decrease disparities in health care. We also ensure all member mailings include appropriate translation instructions and monitor member utilization of the language line.

QAPI program priorities and goals

In 2025, we will remain committed to a seamless enrollee experience with adequate access to high quality, coordinated care and services with the goal to decrease the burden of disease and improve health outcomes. We will prioritize improving the health of our members and reducing health care disparities with our continuing efforts to:

• Improve performance measures through:
  • Monitoring access to care and services
  • Monitoring compliance with prescribed health screenings
  • Enhancing chronic disease management
  • Expanded member and provider outreach initiatives to improve utilization of services
• Strengthen our processes to address care gaps, including:
  • Maintaining effective care management and long-term services and supports programs
  • Improving communication among the plan and medical and behavioral health providers to ensure effective coordination of care
  • Focusing on preventive care, including immunizations and dental care
  • Ensuring effective medication adherence and transitions of care programs
  • Reviewing and updating evidence-based clinical practice guidelines to promote implementation of comprehensive medical and health care practices, including preventive, diagnostic, and treatment services
• Expand efforts to assist and empower members to manage and improve their health in collaboration with their health care providers
• Improve member safety through ongoing monitoring and investigation of potential quality of care issues.

Call Member Services at 1-888-667-0318 (TTY 711),  8 a.m. – 8 p.m., seven days a week, if you would like to learn more.