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Quality Management

The philosophy of our Quality Assessment and Performance Improvement (QAPI) Program is to ensure that members receive access to high-quality care and services in an appropriate, comprehensive, and coordinated manner that meets or exceeds community standards. Emphasis is placed on community-based, individualized, culturally sensitive services designed to enhance self-management and shared decision-making between members, their families, and providers. Our QAPI program promotes objective and systematic measurement, monitoring, and evaluation of services and work processes and implements quality improvement activities based upon the outcomes. The QAPI program uses a continuous measurement and feedback paradigm with equal emphasis on internal and external services affecting the access, appropriateness, and outcomes of care. Our board of directors assumes ultimate responsibility and accountability for the QAPI program and supports a dynamic, communicative, and cooperative approach involving providers, employees and members.

The QAPI program is designed to meet the quality requirements of Centers for Medicare and Medicaid Services (CMS), the Colorado Department of Health Care Policy and Financing (HCPF), and the Division of Insurance (DOI).

The goals and objectives of our QAPI program include (but are not limited to) the following:

  • Maintain a system for monitoring the quality and effectiveness of care and services
  • Prioritize measures and study topics according to epidemiological characteristics of the membership, prior performance, and/or Colorado Access strategic direction
  • Utilize current, evidence-based, scientifically proven practice guidelines, indicators, and benchmarks
  • With input from key providers and stakeholders, systematically collect, review, and analyze valid data and select targeted actions and interventions designed for maximum impact
  • Measure the effectiveness of interventions
  • Lead members to optimal health, satisfaction, and functional status through health education, active collaboration, and community integration
  • Integrate coordination between behavioral and physical healthcare into all aspects of program
  • Demonstrate and sustain improvements in care and services
  • Comply with local, state, federal, and accrediting requirements for quality improvement with special attention to measures and performance levels established by HCPF and CMS

We evaluate the impact and effectiveness of the QAPI program on an annual basis. Copies of these reports can be found below.

 

FY16

ABC Denver Quality Report

ABC Northeast Quality Report

Child Health Plan Plus (CHP+) HMO Quality Report

RCCO Annual Quality Report (Regions 2, 3, and 5)

FY15

Child Health Plan Plus (CHP+) HMO Quality Report

ABC Denver Quality Report

ABC Northeast Quality Report

RCCO Annual Quality Report (Regions 2, 3, and 5)

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