The Quality Improvement (QI) Department is dedicated to providing Priority Partners members with high quality health care services. The QI department monitors, analyzes and reports data, and uses this to come up with strategies to help our members have the best experience possible with every aspect of their health care.

Quality Improvement Program Goals

The QI program has goals in four (4) categories:

  • Member Experience
  • Safety of Clinical Care
  • Quality of Clinical Care
  • Quality of Service

Quality Improvement Initiatives

When we see an opportunity, we create a quality improvement initiative – a focused action to improve the quality of health care services, access to care, or member health outcomes. A quality improvement initiative can be a plan of action for the health care organization, provider, or practitioner. We develop with these initiatives by looking at data from various sources to get the whole picture of what members experience with their health care, including the following:

  • Results of HEDIS measures
  • Results of Population Health Incentive Program (PHIP) measures
  • Member Satisfaction Survey results (CAHPS®)
  • Quality of Care (QoC) reviews
  • Provider Satisfaction Survey results
  • Utilization Management (UM) data
  • Pharmacy and medical claims data
  • Member appeal, complaint and grievance data
  • Provider quality performance data
  • Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator data (provider-level)
  • CMS Hospital Compare website data
  • Health Outcomes Survey results

We also look at quality and safety data from individual doctors and other health care providers, groups, and facilities. When we suspect an issue that might affect members, we look more closely at that provider or facility, tell them if they need to change something, and make sure they follow through on the change.

Annual Evaluations

Every year, the National Committee for Quality Assurance (NCQA) rates Priority Partners and other commercial health plans. Standard measures of clinical quality and customer experience allow people to compare plans and make informed choices for themselves and their families. The NCQA bases their annual ratings on HEDIS® performance and CAHPS® scores.

Commendable: Accreditation status in 2021 through National Committee for Quality Assurance (NCQA®)

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