Your health is important to us. We want our members to receive the best care. We have a Quality Improvement (QI) Program to help us meet this goal and to fix any problems that we find. Each year we set higher goals to improve the service we provide.

QI Program Goals

  • Help doctors and hospitals improve quality of care
  • Help members get the best care
  • Increase member and doctor satisfaction
  • Measure and improve the quality of our service
  • Protect member information

What does the QI Program cover?

  • Access to services in your preferred language
  • Care guidelines
  • Changes and updates to your benefits
  • Getting the right care and services when you need it
  • Health care that respects your culture
  • Individual case reviews, when needed
  • Patient care and safety
  • Services for seniors and persons with disabilities (SPDs)
  • Timely access to care

How do we improve the care and services you receive?

We look at results from data and surveys to watch for things that need to be improved.

One way we do this is through a set of scores called HEDIS® (Healthcare Effectiveness Data and Information Set). These scores tell us how well we are doing when it comes to members getting care they need, like prenatal care if you are pregnant, and lab and eye tests if you have diabetes.

We also ask about member satisfaction with care through a survey, called CAHPS® (Consumer Assessment of Healthcare Providers and Systems). We send this survey out every spring. This survey asks what care and services you use and how you feel about it. We use the answers to improve the service for our members.

If you receive a CAHPS® survey, please complete it and return it to us!

We visit our doctors and health care providers’ offices and facilities to see how we can help them improve.

We also monitor our member’s ability to get care when needed by conducting different surveys, such as the Provider Appointment Availability Survey (PAAS). PAAS reviews the availability of routine and urgent appointments.

As an Alliance member, you have the right to timely access to care.

To view and download the Timely Access to Care chart (coming soon), please select your preferred language:
English | Spanish | Chinese | Vietnamese

Other things we review include what services and medicines members receive, samples of medical records, member’s complaints and appeals and any other issues of concern that we may find.

We make a yearly work plan to improve our service and care. This work plan includes the work we will do, who will do the work, when the work will be done.

We evaluate our work plan every year to determine how we did.

As a part of our work plan we may:

  • Offer members disease management and health programs.
  • Remind members to get screenings, lab tests, and vaccines.
  • Measure the quality of care and service from our doctors and health care providers.
  • Promote increased safety in health care through member and provider education.
  • Work with all Alliance staff and providers in our network to improve the service you receive.

Resources

If you would like to share your ideas for our QI Program or request a paper copy of the QI Program or QI Work Plan, please call: