Clinical Quality Management

Provider Type

  • Physicians 
  • Hospitals
  • Ancillary

The Health Net Prison Health Care Provider Network (PHCPN) Clinical Quality Management (CQM) program monitors quality of care delivered by participating providers and manages potential quality issues (PQIs) as identified. It encompasses all medical and behavioral health providers contracting with Network Providers, LLC (NPLLC). The CQM program includes the measurement of adherence to nationally recognized clinical standards and the implementation of actions to improve quality of care. The scope of the program includes:

  • Monitoring and evaluating care provided in all health care delivery settings, including behavioral health services and the behavioral aspects of health care in coordination with other medical conditions.
  • Clinical quality and safety of care.
  • Hospital quality comparison reports.
  • Provider access and availability for patient.
  • Medical record and documentation standards.
  • Provider qualifications and selection.
  • Monitoring continuity and coordination of care.

Health Net PHCPN has developed quality management systems that extend across the entire continuum of care. All program components are judged on their measurable effect on the patient population. The Health Net PHCPN CQM program is designed to function at the corporate and regional (statewide) level, linked by CQM committees and reporting structures.

Health Net PHCPN does not delegate its comprehensive CQM program or oversight responsibilities to participating providers, hospitals or ancillary providers. Participating providers, hospitals and ancillary providers are required to comply with the standards and requirements set forth in this operations manual and the NPLLC network contract.

Information about the Health Net PHCPN CQM program goals, processes and outcomes as they relate to patient care is available to providers on request through the PHCPN Provider Services Center.