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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.

2015-2016 QI program accomplishments

  • Obtained National Committee for Quality Assurance (NCQA)Health Plan "first" level Accreditation
  • Approved and distributed numerous evidence-based clinical practice guidelines and preventive health guidelines for practitioner and provider use
  • Implemented drug therapy management and medication adherence programs for members
  • Achieved successful Information Systems Capability Assessment and External Quality Review Organization surveys
  • Conducted delegation oversight of vendors and utilization management/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 Health Homes I program in partnership with the District of Columbia Department of Behavioral Health and certified core service agencies
  • Met or exceeded goals in the following Healthcare Effectiveness Data Information Set (HEDIS®) measures:
    • Weight assessment and counseling for children/adolescents (body mass index, nutrition, and physical activity)
    • Childhood immunizations (combo 2)
    • Human papillomavirus vaccine for female adolescents
    • Lead screening in children
    • Cervical cancer screening
    • Chlamydia screening in women
    • Appropriate testing for children with pharyngitis
    • Appropriate treatment for children with upper respiratory infection
    • Use of spirometry testing in assessing and diagnosing chronic obstructive pulmonary disease (COPD)
    • Pharmacotherapy management of COPD exacerbations (bronchodilator)
    • Comprehensive diabetes care — attention to nephropathy
    • DMARD therapy in rheumatoid arthritis
    • Use of imaging studies for low-back pain
    • Follow up for children on attention-deficit/hyperactivity disorder medications (continuation phase)
    • Annual dental visits
    • Adolescent well-care visits

2017 goals

  • Improve member birth outcomes and reduce childhood asthma adverse events
  • Continue to improve health outcomes by identifying and addressing members' gaps in 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 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 primary care providers 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
  • Successfully implement the Health Homes II District-wide Medicaid initiative
  • Reduce unnecessary emergency department visits, potentially preventable hospital admissions, and plan all-cause 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
    • Increase outreach to teens and at-risk members to promote and help them adopt early healthy behaviors
    • Increase efforts to improve member, provider, and community knowledge regarding our dilated eye exam benefit
  • Enhance HEDIS medical record review/data collection process
  • Obtain the NCQA Multicultural Health Care Distinction certification
  • Improve both HEDIS® and CAHPS® performance as described below

AmeriHealth Caritas District of Columbia (HEDIS®)

AmeriHealth Caritas District of Columbia has determined an opportunity for improvement for any HEDIS® 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.

AmeriHealth Caritas District of Columbia Customer Satisfaction Results (CAHPS®)

AmeriHealth Caritas District of Columbia has determined an opportunity for improvement for any CAHPS® score at or below the 75th percentile national benchmark. In the upcoming year we will implement appropriate interventions to positively impact and improve member satisfaction 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, non-profit 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)