Provider Quality Improvement Program
The Health Care Improvement (HCI) quality program provides a formal process to objectively and systematically measure and improve the Health Plan’s quality ratings across all lines of business.
The program is aligned with the Health Plan’s mission “to help people in our communities live healthier and more secure lives through access to high quality, affordable health care,” which also aligns to the Corporate 7 Block Strategy to Improve Member and Community Health.
Key regulatory elements of the HCI quality program include an organization-wide improvement strategy, program description, an annual evaluation of performance, and an annual action/work plan. To support improvement efforts, monthly measurement and reporting also exist to trend and forecast performance.
The Strategic Objectives of Our Quality Improvement Program Are To:
- People: Align a strong motivated workforce that will continually adopt best practices, enhance knowledge, and drive innovation to maximize results across the organization.
- Customer: Create a culture of service excellence by achieving and maintaining outstanding relationships with our members, providers, employers, and community.
- Quality: Implement and sustain an innovative process that drives defined project teams to accomplish milestone outcomes.
- Data: Improve the quality, integrity, and availability of data to support decision making and measure reporting.
For more information regarding our Quality Management Program and our progress towards meeting the goals, please contact us at the number listed on the back of your Member Card, or see the Annual QI Program SummaryOpen a PDF.
How to Report a Concern With Quality of Care Received
If you would like to report a concern with the quality of care you or your family received from doctors, hospitals, or other healthcare facilities, please let us know. The Health Plan investigates and tracks these issues. Please contact Customer Service by calling the phone number listed on your Member Card, or follow this link to email Customer Service email Customer Service.
How to Report Medical Misconduct
Examples of medical misconduct include (but are not limited to): practicing fraudulently, practicing with gross incompetence or gross negligence; practicing while impaired by alcohol, drugs, physical disability or mental disability; being convicted of a crime; filing a false report; guaranteeing that treatment will result in a cure; refusing to provide services because of race, creed, color or ethnicity; performing services not authorized by the patient; harassing, abusing or intimidating a patient; ordering excessive tests; and abandoning or neglecting a patient in need of immediate care.
The mission of the New York State Department of Health Office of Professional Medical Conduct is to protect the public through the investigation of professional discipline issues involving physicians and physician assistants. OPMC is responsible for investigating all complaints of misconduct, coordinating disciplinary hearings that may result from an investigation, monitoring physicians whose licenses have been restored after a temporary license surrender and monitoring physicians and physician assistants placed on probation as a result of disciplinary action.
If you feel that your doctor has committed misconduct, you should file a report with the Office of Professional Medical Conduct. Reports of misconduct are kept confidential.