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HAP's Quality Program

The Quality Management Department (QM) is responsible for ensuring that health care services provided to members are of the highest quality and undergo continuous improvement. The following elements are at the heart of our Quality Program:

  • Healthy Living Guidelines. HAP has adopted preventive service guidelines for adult and pediatric patients. These run the gamut of health care services from delivery of immunizations, to patient education and guidance, to screening for early detection of disease. QM periodically audits PCPs for compliance with these guidelines.
     
  • Clinical Practice Guidelines. QM staff also develop guidelines which outline specific, well-accepted clinical treatments for certain medical conditions. The guidelines are evidence-based, with a goal of achieving consistent, high-quality patient outcomes. Currently, QM has adopted clinical practice guidelines for treatment of patients with congestive heart failure (CHF), diabetes, asthma, depression, Attention Deficit Hyperactivity Disorder (ADHD), coronary artery disease (CAD), hypertension, pre-term labor, high cholesterol, and anticoagulation therapy.
     
  • HEDIS®. Also known as the Health Plan Employer Data and Information Set, HEDIS describes a comprehensive, standardized set of indicators used to measure the performance of a health plan. Each year, QM conducts an extensive data collection and performance analysis that customers can use to identify trends, make informed choices about health care, and witness HAP's ongoing commitment to improved performance.
     
  • Site Visits/Facility and Medical Record Reviews. As a component of the credentialing process, potential practitioners such as PCPs, Ob/Gyns and independent practicing psychologists must pass HAP's facility and medical record keeping practices review. All affiliated practitioners are required to comply with HAP's facility and medical record standards. HAP QM coordinators (RNs) provide support and compliance education as required. HAP sometimes employs vendors to conduct credentialing site visits.
     
  • Peer Reviews. The Peer Review Committee is composed of HAP Associate Medical Directors who investigate potential quality of care cases (such as member quality complaints identified through a "tiered-review" process). Investigations generally incorporate the physician/provider's response and, regardless of the case outcome, the data is routinely reviewed during the recredentialing process.

For more information about HAP's Quality Program, including program goals, and our progress toward meeting those goals see the following:

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