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Quality Improvement Program

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).