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:

 

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

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

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

Frequently asked questions

See questions our members ask most frequently about Blue Shield Promise Medi-Cal.

Read FAQs

Member rights and responsibilities

Find out about your rights and responsibilities as a Blue Shield Promise Medi-Cal member.

Learn about member's rights and responsibilities

Health Care Options: 1-844-580-7272, Monday through Friday from 8 a.m. - 6 p.m. TTY users should call 1-800-430-7077.

For information on Blue Shield Promise Cal MediConnect Plan and other Cal MediConnect options for your health care, call the Department of Health Care Services at 1-800-430-4263 (TTY: 1-800-735-2922), or visit https://www.healthcareoptions.dhcs.ca.gov/.

Blue Shield of California Promise Health Plan is a managed care organization, wholly owned by Blue Shield of California, offering Medi-Cal and Cal MediConnect Plans.

© 2002-2023. California Physicians’ Service DBA Blue Shield of California Promise Health Plan. All rights reserved.

California Physicians’ Service DBA Blue Shield of California Promise Health Plan is an independent licensee of the Blue Shield Association.

The provider network may change at any time. You will receive notice when necessary.

Blue Shield of California Promise Health Plan complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.

Blue Shield of California Promise Health Plan cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, país de origen, ascedencial, religión, sexo, estado civil, genero, identidad de genero, orientación sexual, edad ni discapacidad.

Blue Shield of California Promise Health Plan 遵循適用的州法律和聯邦公民權利法律，並且不以種族、膚色、原國籍、血統、宗教、性別、婚姻 狀況、性別認同、性取向、年齡或殘障為由而進行歧視。

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Blue Shield of California Promise Health Plan, 601 Potrero Grande Drive, Monterey Park, CA 91755.

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