Cap Management Systems offers a comprehensive Quality Improvement Program that continuously evaluates monitors and strives to improve the quality of care provided to our IPA's members. Our Quality Interdisciplinary Improvement Committee (QIOC) is comprised of all disciplines within the organization so that we align company objectives to quality improvement. Participation in industry sponsored programs and seminars aid us in remaining up to date with industry collaborative efforts such as Pay for Performance and Health Plan specific quality programs including Cal Optima in Orange County. Quality Improvement initiatives are designed to afford providers the ability to effectively manage members by providing focused and office specific information identifying the needs of members. Contracted providers throughout the year receive report cards profiling utilization, encounter data submission (key to Pay for Performance and other administrative data-based compensation programs) as well as Hedis compliance rates. Our Hedis reminders, supported by Q-Marks’ Hedis-Help, enable physicians to identify members needing preventative exams such as Breast and Cervical Cancer Screening.
Compliance reports allow providers to measure their compliance rates compared to those of their peers. Among other services, our provider education on Health Employer Data Information Sets (HEDIS) is a key focus. CMS staff provides helpful tools and training to provider offices to continuously educate both the provider and their staff to achieve the ultimate goal of improving the health status of members.
QIOC committee representatives also conduct surveys of patients and providers to identify areas of improvement. Monitoring and tracking of member grievances and identifying potential quality of care issues is also a major focus.
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