Quality Improvement Program

AmeriHealth Caritas Pennsylvania's Quality Improvement Program

AmeriHealth Caritas has a Quality Improvement (QI) Program to monitor and evaluate the health care services used by our members. Services are monitored to see that they:

  • Meet quality guidelines
  • Are appropriate
  • Are efficient
  • Are effective

The Quality Improvement Committee (QIC) oversees the QI Program. The QIC is made up of AmeriHealth Caritas' health care professionals, associates and local health care providers. Every year, the QI Program sets goals to improve member health outcomes and services and conducts activities to meet the goals.

Goals
The overall goal of the QI Program is to provide high quality and safe clinical care and services to all members. To meet this goal, the QI Program manages and analyzes data and takes action to manage risks.

Evaluation
Every year, AmeriHealth Caritas evaluates the QI Program to see how well it meets its goals. We look at all parts of the QI Program, including clinical and service activities.  The evaluation includes suggestions to improve the QI Program and goals for the next year.  It also identifies the resources needed to meet the goals and objectives.

Accomplishments for 2011 QI Program:

  • Improved our national ranking from 23rd to 22nd (U.S. News & World Report’s rankings of Best National Medicaid Plans)
  • Maintained NCQA Excellent accreditation
  • Awarded the NCQA’s Multicultural Health Care Distinction
  • Significant improvement of the Health Plan Employer Data and Information Set (HEDIS) measures:
    • Breast cancer screening
    • Chlamydia screening
    • Diabetes screening/testing
    • Diabetes cholesterol screening/testing
    • Diabetes cholesterol lower than 100 mg/dl
    • Ongoing visits for prenatal patients
    • Annual dental care for 2 to 21 year olds

Program Goals

  • Maintain NCQA Excellent accreditation status
  • Strengthen childhood obesity interventions
  • Continue to improve HEDIS measures by identifying gaps in care
  • Continue to improve member satisfaction survey results
  • Continue collaborative efforts with behavioral health organizations

If you would like additional information about the QI Program, please call Provider Services at 1-800-521-6007.