Quality Improvement Program

The Alliance Quality Improvement (QI) Program is designed to continuously improve the health of our members and their healthcare experience.

Through the use of different data sources, the Alliance can measure the effectiveness of our initiatives, identify opportunities for improvement, and implement interventions designed to support our providers and members.

Click here to view the 2016 Quality Program Description.

Program Goals

The purpose of the Alliance QI Program is to assess, monitor and improve the quality of care, service, and safety of health care for our members.

The program goals are to:
  • Measure quality
  • Help doctors and hospitals improve quality
  • Help members get better quality care
  • Keep the costs of health care low
  • Protect member information

Program Scope

The scope of the QI program is comprehensive and encompasses major aspects of care and service in the Alliance delivery system, and the clinical/non-clinical issues that affect its membership. These include:

  • Availability and access to care, clinical services, and care management
  • Cultural and linguistic issues
  • Special needs populations including Seniors and Persons with Disabilities or persons with chronic conditions
  • Patient safety
  • Member and provider satisfaction
  • Continuity and coordination of care
  • Utilization trends including over-and under-utilization
  • Clinical practice guideline development, compliance, and revision
  • Acute, chronic, and preventive care services for children and adults
  • Perinatal, primary, specialty, emergency, inpatient, and ancillary care
  • Case review of suspected instances of poor quality
  • Credentialing and recredentialing services

QI Methods and Procedures

The Alliance uses several methods to identify aspects of care that are the focus of QI activities. Particular attention is paid to those areas in which members are high risk, high volume, high cost, or problem prone.

HEDIS®

The Alliance’s QI strategies focus on measurement of quality and identifying opportunities for improvement. One way we assess our quality of care is through HEDIS (Healthcare Effectiveness Data and Information Set). For more information about HEDIS® and tools to help you with the HEDIS® measures, click here.

CAHPS®

Annually, the Alliance measures member satisfaction using the CAHPS® (Consumer Assessment of Healthcare Providers and Systems) survey. The survey looks at health plan performance and members’ experiences in the provider office. The survey is sent to members and parents of child members every Spring. The Alliance uses the survey results to identify opportunities to improve member satisfaction. For more information about CAHPS®, click here.

Other Data Sources

Data sources used to identify areas of improvement also include, but are not limited, to the following:

  • Claim and encounter submissions
  • Credentialing, medical record review, and audit findings
  • Pre-service, concurrent, post-service and pharmacy utilization review data
  • Member and provider grievance and appeal data
  • Potential Quality Issue tracking/trending data 

Annual Work Plan

The Alliance prepares an annual QI Work Plan that describes the quality management goals and objectives, planned projects, and activities for the year, including continued follow-up on previously identified quality issues, and a mechanism for adding new activities to the plan as the need is identified. The work plan delineates the responsible party and the time frame in which planned activities will be implemented.

The work plan addresses the following:

  • Quality of clinical care
  • Quality of service
  • Safety of clinical care
  • Program scope
  • Yearly objectives
  • Yearly planned activities
  • Time frame within which each activity is to be achieved
  • The staff member responsible for each activity
  • Monitoring previously identified issues
  • Evaluation of the QI program

If you would like a copy of the current QI work plan, please contact Provider Services.

Annual Evaluation

For More Information

Provider feedback is important to the success of our QI program. If you would like to share your suggestions about our QI program, or to request more information about the Alliance’s QI Program or to request a paper copy of our detailed QI Program Description, please contact us.