Quality Improvement

How we work to improve your health care

Your health is important to us. We want our members to receive great 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 goals to improve the service we provide.

The QI Program Goals are:

  • Measure quality
  • Help doctors and hospitals improve quality
  • Help members get better care
  • Keep the costs of health care low
  • Protect member information

The QI Program touches all aspects of your health care

  • Access to care
  • How well doctors, specialists and your health plan work as a team to get you the care you need
  • Access to services in your language
  • Health care that respects your culture
  • Services for older adults and people with disabilities
  • Patient safety
  • Changes in use of services
  • Guidelines for patient care
  • Case reviews when needed

How we improve the health care you receive:

First, 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, such as 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 out this survey each spring.  If you receive a survey, please take time to complete and return to us!  This survey asks what care and services you use and how you feel about it. We use the answers to improve the service for members.
  • 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 we find.

Second, we make a yearly work plan to improve our service and care.  This plan includes what we will do, who will do the work, by when it must be done and how well it worked. 

As a part of the work plan we may:

  • Offer members disease and health programs
  • Remind members to get screenings,  lab tests, and vaccines
  • Assess the quality of care and service of our doctors and health care providers
  • Promote safety in health care through education for members and doctors
  • Work with all Alliance staff and providers to improve service to you

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 contact Member Services at 510-747-4567.