Overview

The Health Net Quality Improvement (QI) program manages improvement of the quality of care and service provided to Health Net members. It encompasses all providers, including all medical, behavioral health and ancillary providers, contracting with Health Net. The QI program includes the development and implementation of standards for clinical care and service, the measurement of adherence to the standards and the implementation of actions to improve performance. The scope of the program includes:

• Wellness is a component of the Decision Power^® whole-person approach to care.
• Practice guidelines for prevention and chronic care.
• Monitoring and evaluating care and services provided in all health care delivery settings, including behavioral health services and long-term services and supports (LTSS) in coordination with other medical conditions.
• Clinical quality and safety of care.
• Member, practitioner and provider satisfaction.
• Hospital quality comparison reports.
• Practitioner and provider site and facility inspections.
• Medical record and documentation standards.
• Practitioner and provider qualifications and selection.
• Organizational performance.
• Support for cultural and linguistic services.
• Continuity and coordination of care.
• Maintaining compliance with the QI requirements of regulatory agencies, such as the Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS) and the Department of Managed Health Care (DMHC), and the California Department of Insurance (CDI).

Health Net has developed quality management systems that extend across the entire continuum of care, with special emphasis on preventive services and managing chronic conditions. All program components are evaluated on their measurable effect on Health Net's populations.

Participating providers, hospitals and ancillary providers are required to comply with the standards and requirements set forth in Health Net's operations manuals.

Health Net regularly communicates information about Health Net's QI program goals, processes and outcomes as they relate to member care through provider updates, Online News articles and other forums. QI program information is also available to providers on request through Health Net's Provider Services Center.