Quality: An Investment in Our Members and Our Partners

A radical transformation takes place when we put our care beyond medicine to work for our members. With it, we address their clinical and social needs to change lives. At the same time, we save our partners money. A fundamental and interconnected part of our care model is our Quality Improvement (QI) Program. We use evidence-based clinical guidelines, provider training and profiling, and actionable data to help members stay adherent with preventive practices and disease-specific protocols. Our members have not had the benefit of the best clinical care or have had important services deferred.

Our program populations come to us below the NCQA 50^th percentile or below a three-Star CMS rating. Through our data-driven and member-centric programming, we achieve the following outcomes:

• NCQA performance increase to the 75^th, 90^th, and 95^th percentiles
• CMS Star ratings of four and five for provider-driven measures
• Increased risk adjustment documentation capture
• Improved member experience with their health plan and their care

QI Program

Our QI Program is custom-built for each partner, leveraging our dynamic model’s core components for data, programs, engagement, and governance. To maximize collaboration, we engage in tailored evaluation cycles with each partner, ongoing planning and performance workgroups, and precision-targeting for intervention and data capture. Our program is made successful through our deep integration with our clinical and operations team members at every level of the organization. The QI Program includes features such as: