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Committed to Quality Care for Our Members

First Choice has a Quality Improvement Program (QI) Program to monitor, evaluate and improve the quality of healthcare services received by our members. We use nationally known ways to check how we are doing and how we can improve our services to you. Services are monitored to see that they:

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

The Quality Assurance Performance Improvement Committee (QAPIC) oversees Select Health’s efforts to measure, manage and improve the quality of care and services delivered to plan members, and evaluate the effectiveness of the QAPI program. Every year, the QI program sets goals to improve member health outcomes and services, and conducts activities to meet these goals.

The overall goal of the Quality Assurance and Performance Improvement program is to improve the quality and safety of clinical and behavioral healthcare and services provided to members by establishing a comprehensive quality management structure and program.

Every year, First Choice evaluates the QI Program to determine if the goals have been met. All parts of the program are evaluated, including clinical and service activities. The evaluation includes suggestions to improve the QI Program and goals for the next year. It also indentifies the resources needed to meet the goals and objectives.

Accomplishments for the 2011 QI Program

• Achieved improvement and met plan goals in the following Health Plan Employer Data and Information Set (HEDIS®) measures:
  • Cervical cancer screening
  • Appropriate testing of children with pharyngitis
  • Children who received Combo 2 vaccines by 2 years of age
  • Well visits in the 3rd, 4th, 5th and 6th years of life
  • Annual retinal eye exams for diabetic members
  • Adolescent well visits
  • Members with asthma receiving annual flu vaccines
• Maintained NCQA’s highest rating of excellent” for NCQA Accreditation in 2011
• Achieved Multicultural Healthcare distinction through NCQA
• Completed new member quarterly mailings and 10 mailings for members diagnosed with asthma to promote education and self-management of asthma symptoms and health care needs
• Initiated member contact for all inpatient hospitalizations to assist with discharge needs to promote a decrease in need for readmission
• Fully implemented the “Make Every Member Count” initiative to improve member contact in both inbound and outreach units
• Published member newsletter articles dedicated to specific safety concerns to include summer safety, fire safety tips and use of seat buckles

Program Goals for 2012

• Maintain NCQA “Excellent” Accreditation
• Maintain Multicultural Healthcare distinction through NCQA
• Continue collaborative efforts across the organization and implement interventions to improve the plan’s overall HEDIS® and CAHPS survey results
• Implement a pilot program via the plan website to provide online access for diabetic and asthma education to supplement quarterly educational mailings
• Continue development and promotion of care gap identification capabilities for providers and the plan

View detailed quality data

If you would like more information about our quality program, please call Member Services at 1.888.276.2020.