Last updated: Nov. 12, 2020
UnitedHealthcare Community Plan’s comprehensive Quality Improvement program falls under the leadership of the CEO and the chief medical officer. A copy of our Quality Improvement program is available upon request.
The program consists of:
- Identifying the scope of care and services given
- Developing clinical guidelines and service standards
- Monitoring and assessing the quality and appropriateness of services given to our members based on the guidelines
- Promoting wellness and preventive health, as well as chronic condition self-management
- Maintaining a network of providers that meets adequacy standards
- Striving for improvement of member health care and services
- Monitoring and enhancing patient safety
- Tracking member and provider satisfaction and taking action as appropriate
- As a participating care provider, you may offer input through representation on our Quality Improvement Committees and through your Provider Services representative/Provider Advocate.
- You must comply with all quality-improvement activities. These include:
- Providing requested timely medical records
- Cooperation with quality-of-care investigations. For example, responding to questions and/or completing quality-improvement action plans
- Participation in quality audits, such as site visits and medical record standards reviews, and taking part in the annual Healthcare Effectiveness Data and Information Set (HEDIS®) record review
- Requested medical records at no cost (or as indicated in your Participation Agreement with us). You may provide records during site visits or by email or secure email
- Practitioner appointment access and availability surveys
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).