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Quality Improvement

Committed to quality care for our members

AmeriHealth Caritas District of Columbia has a quality improvement (QI) program to monitor the quality of services our members receive. Our goal is to make sure the health care and services members and their families get are:

  • High quality
  • Safe
  • Appropriate
  • Efficient
  • Effective

We review our program each year to see how we are doing. This evaluation includes suggestions for improvement as well as goals for the next year.

Accomplishments for 2016 – 2017

  • Obtained the National Committee for Quality Assurance (NCQA) Multicultural Health Care Distinction certification
  • Approved and distributed numerous evidence-based clinical practice guidelines and preventive health guidelines for provider use
  • Implemented drug therapy management and medication adherence programs for members
  • Achieved successful Information Systems Capability Assessment (ISCA) and External Quality Review Organization (EQRO) surveys
  • Conducted delegation oversight of vendors and Utilization Management and Credentialing delegates to ensure quality of care, customer service, and member safety
  • Implemented numerous Consumer Assessment of Healthcare Providers and Systems (CAHPS®) initiatives to improve scores and member satisfaction
  • Implemented the Care 4 U: Meds Made Easy program
  • Implemented the My Health GPS program in partnership with the D.C. Department of Health Care Finance and primary care providers
  • Met or exceeded goals in the following Healthcare Effectiveness Data and Information Set (HEDIS®) measures:
    • Weight Assessment and Counseling for Children/Adolescents (BMI, nutrition, and physical activity)
    • Lead Screening in Children (LSC)
    • Cervical Cancer Screening (CCS)
    • Chlamydia Screening in Women (CHL)
    • Appropriate Testing for Children with Pharyngitis (CWP)
    • Appropriate Treatment for Children with Upper Respiratory Infection (URI)
    • Avoidance of Antibiotic Treatment for Adults with Acute Bronchitis (AAB)
    • Disease Modifying Anti-Rheumatic Drug Therapy in Rheumatoid Arthritis (ART)
    • Cardiovascular Monitoring People with Cardiovascular Disease and Schizophrenia (SMC)
    • Metabolic Monitoring Children/Adolescents on Antipsychotics (APM)
    • Children and Adolescents' Access to Primary Care Practitioners (CAP) (12 – 24 Months)
    • Children and Adolescents' Access to Primary Care Practitioners (CAP) (7 – 11 Years)
    • Children and Adolescents' Access to Primary Care Practitioners (CAP) (12 – 19 Years)
    • Annual Dental Visit (ADV)
    • Well-Child Visits in the 3rd, 4th, 5th, and 6th Years of Life (W34)
    • Adolescent Well-Care Visits (AWC)

2018 goals

  • Improve member birth outcomes and reduce childhood asthma adverse events
  • Continue to improve health outcomes by identifying and addressing gaps in members’ care
  • Coordinate activities to promote member safety focusing on improving member knowledge about medications, home safety, and hospital safety
  • Monitor cross-cultural member issues and develop mechanisms for real-time resolution
  • Conduct annual provider and practitioner satisfaction surveys
  • Continue collaborative efforts with behavioral health organizations to improve all aspects of member care
  • Strengthen community and member outreach activities
  • Identify and prioritize opportunities to implement or redesign clinical programs to improve health care equality and decrease health care disparities
  • Review performance report cards with PCPs to improve member health outcomes and reduce adverse events
  • Educate providers about use of NaviNet to identify non-adherent and disengaged members assigned to their practices
  • Reduce unnecessary emergency department visits and potentially preventable hospital admissions and readmissions
  • Improve and implement initiatives aimed at behavioral health measures and outcomes
  • Improve comprehensive diabetes care through:
    • Earlier identification and outreach to new members, with a focus on screening and control measures for HbA1C
    • Increasing outreach to teens and at-risk members to promote and help them adopt good behaviors earlier
    • Increasing efforts to improve member, provider, and community knowledge of our dilated eye exam benefit
  • Enhance HEDIS medical record review and data collection process
  • Improve both HEDIS and CAHPS performance as described below

Quality performance data (HEDIS) and customer satisfaction results (CAHPS)

AmeriHealth Caritas District of Columbia has determined an opportunity for improvement for any HEDIS or CAHPS score at or below the 75th percentile national benchmark. We will strive in the upcoming year to implement appropriate interventions to positively impact and improve measures in these areas.

For more information about our QI program:

  • Members can call Member Services at 202-408-4720 or toll free at 1-800-408-7511 (TTY/TDD: 202-216-9885 or 1-800-570-1190)
  • Providers can call Provider Services 202-408-2237 or 1-888-656-2383

About NCQA

NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers, and researchers. NCQA Health Plan Accreditation is a voluntary review process that evaluates the quality of health care that health plans provide to their members.

View quality data (PDF)