Providers | Blue Shield Promise Health Plan

Quality Improvement

Quality Improvement

The Quality Improvement (QI) Department identifies opportunities for improvement of care and services to both our members and providers. This is accomplished by assisting with the identification, investigation, implementation and evaluation of corrective actions that continuously improve and measure the quality of clinical and administrative service. This Quality Improvement Program covers all lines of business, including but not limited to, Medi-Cal, Medicare and Healthy Families. A formal evaluation of the Quality Improvement functions is performed annually.

Focus Area

Specific key elements of focus for the Quality Improvement Department may include but are not limited to:

  • Provider accessibility and availability
  • Provider satisfaction
  • Provider credentialing
  • Clinical practice guidelines
  • Under and over utilization
  • Adverse outcomes/sentinel events
  • Medical record keeping practices
  • Facility site reviews
  • Member satisfaction/grievances
  • Timeliness of handling claims
  • High risk and high volume services
  • Oversight of IPA QM function

The Quality Improvement Program is designed to objectively and systematically monitor and evaluate the quality, appropriateness and outcome of care and services delivered to our members and to provide mechanisms that continuously pursue opportunities for improvement and problem resolution.

Annual Evaluations/ Program Goals:

Click here to view full Quality Improvement Executive Summary (Goals/Achievements)

Provider Notifications/Updates (NCQA )

The Postpartum Care Incentive Program

The Postpartum Care Incentive Program is created to educate our new mothers on the importance of their postpartum care visit. The postpartum visit should be scheduled between 21 to 56 days after their delivery. To encourage our members/new mothers to come in for their check up, we give a $40.00 gift card once the mother has come in for their postpartum visit. As a new mom it is important to make sure that the mom/mother is well from labor. For taking care of our members, we give the providers a $50.00 incentive. Read more.

Initial Health Assessment (IHA)

Facility Site Review Policy and Procedures

Site Accessibility by individuals with physical disabilities; Fire Safety and Prevention and Emergency Non-Medical Procedures; Medical and lab equipment maintenance; Emergency healthcare services; Staff qualifications... Click on the following link for the complete Facility Site Review Policy and Procedures.

More on Quality Improvement

Access to Care Standards, Provider Survey Results, Survey Results (CAHPS®), Study Results (HEDIS®), Care1st CARES Programs... Click here!

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