20-451 Help Your Patients Achieve Better Health Outcomes

Date: 09/03/20

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

For Medi-Cal, this information applies to Kern, Los Angeles, Sacramento, San Diego, San Joaquin, Stanislaus, and Tulare counties.

SUMMARY UPDATE

Use quality management programs and resources to support the care you give

Health Net’s Medi-Cal quality management program is designed to monitor and assess the appropriateness of health and administrative services on a regular basis. A complete overview of the quality management program components is described in provider update 20-451, Help Your Patients Achieve Better Health Outcomes, available here.

Quality improvement program scope

The program includes developing and implementing standards for clinical care and services, measuring conformance to the standards, and implementing actions to improve performance.

The scope of the program includes:

• Impact of COVID-19.
• Quality performance improvement projects.
• Quality measures and surveys.
• MHN outreach program.
• Disease management.  
• Health education programs, services and resources.
• Case management program.
• Clinical practice and preventive health guidelines.
• Initial health assessments.
• Health risk assessment.
• Notice of access standards.
• Medical record documentation standards.
• Medical record, facility site and physical accessibility reviews.
• Utilization management.
• Pharmaceutical management.
• Rights and responsibilities.
• Member appeals and grievances.
• Privacy and confidentiality.
• Interpreter services.

Go online for more information

More information on all the programs listed above is available on the Health Net provider website at provider.healthnet.com.

Also online is the Quality Improvement Corner. Here you can view Health Net’s quality outcomes and progress toward goals. You can also access tools and materials to help you give the care that members expect. Go to provider.healthnet.com > Working with Health Net > Quality.

Additional information

A complete copy of Health Net’s quality improvement (QI) program description is available upon request by email at cqi_dsm@healthnet.com.

Providers are encouraged to access the provider portal online at provider.healthnet.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact the Health Net Medi-Cal Provider Services Center within 60 days at 1-800-675-6110.