MEDI-CAL Providers Quality Improvement

Quality Improvement

Quality Improvement

The Quality Improvement (QI) Department identifies opportunities for improvement of care and services to both our members and providers. This is accomplished by assisting with the identification, investigation, implementation and evaluation of corrective actions that continuously improve and measure the quality of clinical and administrative service. This Quality Improvement Program covers all lines of business, including but not limited to, Medi-Cal, Medicare and Healthy Families. A formal evaluation of the Quality Improvement functions is performed annually.

Focus Area

Specific key elements of focus for the Quality Improvement Department may include but are not limited to:

  • Provider accessibility and availability
  • Provider satisfaction
  • Provider credentialing
  • Clinical practice guidelines
  • Under and over utilization
  • Adverse outcomes/sentinel events
  • Medical record keeping practices
  • Facility site reviews
  • Member satisfaction/grievances
  • Timeliness of handling claims
  • High risk and high volume services
  • Oversight of IPA QM function

The Quality Improvement Program is designed to objectively and systematically monitor and evaluate the quality, appropriateness and outcome of care and services delivered to our members and to provide mechanisms that continuously pursue opportunities for improvement and problem resolution.