Quality improvement initiatives

Blue Shield of California Promise Medi-Cal Health Plan wants to make sure our members get good care and services. We have created a Quality Improvement Program (QIP) to monitor and evaluate the 

• Quality
• Appropriateness 
• Outcome 

of services our members receive. QIP also helps us improve care and services to both our members and providers.

The Quality Improvement Program focuses on multiple areas, including but not limited to:

• Provider accessibility, availability of appointments and after-hours services, and appointment wait times
• Provider credentialing and satisfaction
• Clinical practice guidelines
• Prescription drugs under- and over utilization
• Medical record keeping practices
• Facility site reviews, including access for disabled people
• Member/patient satisfaction and grievances
• Timeliness of claims handling
• Quality of care studies to assure appropriate:
  • Well child visits and immunizations
  • Annual physical exams for adults
  • Cervical and breast cancer screenings
  • Diabetes, asthma, and high blood pressure care and management
  • Prenatal and postpartum care
  • Cholesterol management
  • Alcohol misuse screening and counseling 
     

As a part of QIP, Blue Shield Promise Medi-Cal has programs to help members to manage their medical conditions. These include Congestive Heart Failure and Chronic Obstructive Pulmonary Disease (COPD).

Read about these and other health and wellness programs for our members.

QIP results are evaluated annually. For an example of how we evaluate the quality of our services, see the 2018 Quality Improvement Executive Summary:

• LA Care (Medi-Cal) Quality Improvement Executive Summary, English (PDF, 348 KB)
• LA Care (Medi-Cal) Quality Improvement Executive Summary, Spanish (PDF, 176 KB)
• Medi-Cal Quality Improvement Executive Summary, San Diego, English (PDF, 348 KB)
• Medi-Cal Quality Improvement Executive Summary, San Diego, Spanish (PDF, 176 KB)

To request the QIP evaluation results, please call Member Services, 8 a.m. to 6 p.m., Monday through Friday:

 Los Angeles: (800) 605-2556 (TTY: 711)

 San Diego: (855) 699-5557 ((TTY: 711)