Quality Improvement Program | Ambetter from NH Healthy Families

 

Quality Improvement (QI) Program

The Quality Improvement (QI) program is an important part of your Health Plan.  The QI department supports our goal of improving member healthcare. 

The QI Program monitors the quality of care and services provided in the areas below:

  • Making sure members get the care they need, when and where they need it
  • Making sure that members are receiving quality care
  • Cultural needs of our members
  • Member satisfaction
  • Member/Patient Safety and Privacy
  • Offering a wide variety of provider specialties
  • Health plan services members are using

The goal of the QI program is to improve member health. This is achieved through many different activities. 

Some of our Quality Improvement goals include the following: 

  • Good health and quality of life for all members
  • Care provided by Plan Healthcare Providers meets industry-accepted standards of care
  • Plan customer service meets industry-accepted standards of performance
  • Provide members with Preventive Care reminders annually
  • Incomplete or duplicate services will be kept to a minimum through QI activities across Plan departments
  • The Member experience will meet the Plan’s expectations
  • Compliance with all State and Federal laws and regulations
  • Evaluate the quality of health care through HEDIS® (Healthcare Effectiveness Data and Information Set). These scores tell us when you have received the type of care you need.
  • Check out our HEDIS® rates and results here (information coming soon).

Click here (information coming soon) if you would like to learn more about our Quality Improvement activities.

Ambetter from NH Healthy Families' Quality Improvement (QI) Program focuses on preventive health. The program creates plans, puts those plans into action, and measures efforts to improve your health and safety. 

The QI Program strives to make a difference in health outcomes. It develops actions to improve member and provider satisfaction. Ambetter from NH Healthy Families involves providers within our plan. The providers assist with developing and monitoring activities of the QI Program as well as providing insight into preventive health resources and information.

For questions about the QI Program and our progress on meeting goals, call the Member Services department at 1-844-265-1278 (TDD/TTY 1-855-742-0123).

The QI Program also reviews services provided to our members. We have clinical practice guidelines for certain conditions. If you would like a copy of these guidelines or need more information about programs call us at 1-844-265-1278 (TDD/TTY 1-855-742-0123).

Information and/or a full copy of Ambetter from NH Healthy Families' current QI Program Description is available upon request.