Quality Improvement (QI) Program
We are committed to the provision of a well-designed and well-implemented Quality Improvement (QI) Program. Our culture, systems, and processes are structured around this mission to improve the health of all enrolled members.
Goals and Objectives
Our primary QI goal is to ensure that Absolute Total Care's members have access to the highest quality of health care services that is responsive to their health needs and able to improve their health outcomes.
The scope of the QI Program is comprehensive and addresses both the quality and safety of clinical care and quality of service provided to Absolute Total Care's members. We incorporate all demographic groups, benefit packages, care settings, and services in QI activities, including preventive care, emergency care, primary care, specialty care, acute care, short-term care, long-term care (depending upon Absolute Total Care's products), and ancillary services.
Absolute Total Care's QI Program monitors the following:
- Acute and chronic care management
- Behavioral health care services
- Clinical quality initiatives
- Compliance with member confidentiality laws and regulation
- Compliance with preventive health and clinical practice guidelines
- Continuity and coordination of care
- Delegated entity oversight
- Department performance and service
- Member and provider cultural competency
- Member enrollment and disenrollment
- Member grievance and appeal system
- Member satisfaction
- Patient safety
- Medical record documentation
- Pharmacy services
- Provider and Absolute Total Care after-hours telephone accessibility
- Provider appointment availability and accessibility
- Provider network adequacy and capacity
- Provider satisfaction
- Quality of care review
- Selection and retention of providers (credentialing and recredentialing)
- Utilization management, including under- and over-utilization
For consideration to participate in the Absolute Total Care network, all licensed physicians and other licensed healthcare professionals who have an independent relationship with Absolute Total Care must complete an application for participation and submit copies of applicable supporting documentation.
Culturally and Linguistically Appropriate Services (CLAS) Program
Absolute Total Care is committed to establishing multicultural principles and practices throughout its organizational systems of services and programs. That mission is supported by facilitating the process by which Absolute Total Care can respond to the healthcare needs of all individuals, regardless of their ethnic, cultural, religious beliefs, or language. Our Culturally and Linguistically Appropriate Services (CLAS) program is reviewed and updated annually. To view our current CLAS program, please view the Culturally and Linguistically Appropriate Services (CLAS) (PDF).
QI Program Participation
Absolute Total Care requires providers and practitioners to cooperate with all QI activities as well as allow the use of provider and/or practitioner performance data to ensure the success of the QI Program. More information about the Absolute Total Care QI Program is outlined below. You can also call Provider Services at 1-866-433-6041 and ask to speak with the Quality Improvement Department.
QI Program Resources
- Medicaid Quality Improvement Program Information (PDF)
- Medicare-Medicaid Plan (MMP) Quality Improvement Program Information (PDF)
- Healthcare Effectiveness Data and Information Set (HEDIS)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS)
- National Committee for Quality Assurance (NCQA)
- Medical Records
- Practice Guidelines
- Providing Quality Care
- CPTII Codes and HCPCS Billing
- Culturally and Linguistically Appropriate Services (CLAS) Program (PDF)
- Social Determinants of Health (SDOH) (PDF)