Quality
AlohaCare’s Quality Improvement Program is built on a foundation of dedication to high quality collaborative relationships with providers, practitioners, members, and commitment to continuous improvement in effective, efficient and timely care and service. AlohaCare’s commitment to continuous improvement in care and services is the underpinning for the quality improvement program.
Goals
AlohaCare's primary quality improvement goal is to improve members' health status through a variety of activities implemented across all care settings and aimed at improving quality of care and services delivered, while promoting safe clinical practices.
Scope
The scope of AlohaCare's Quality Improvement Program is comprehensive and encompasses all clinical care service aspects.
- Availability of services
- Behavioral health services
- Clinical quality improvement
- Member experience
- Practitioner experience
- Clinical practice guidelines
- Preventive health guidelines
- Continuity and coordination of care
- Patient safety
- Practitioner performance
- Effectiveness of the quality improvement program
Methods and Measures
The scope of AlohaCare's Quality Improvement Program is comprehensive and encompasses all clinical care service aspects.
AlohaCare's Quality Improvement Program relies on both external and internal processes to measure quality. Outside organizations, such as NCQA, Medicare, HSAG and other agencies are measuring our performance based on National Standards, such as Core Set Measures, HEDIS, CAHPS, EQRO, STARS and NCQA accreditation. Internally, we remain focused on providing superior service to our members, providers, and other external partners. Our goal is to be viewed as the best MCO partners in Hawaii. We measure our success by reviewing and addressing complaints, grievances, quality of care concerns and appeals of our prior authorizations. We welcome comments on our performance in meeting all our Quality goals. Please send any comments to June Mellor at jmellor@alohacare.org.
AlohaCare’s Quality Improvement Program is built on a foundation of dedication to high quality collaborative relationships with providers, practitioners, members, and commitment to continuous improvement in effective, efficient and timely care and service. AlohaCare’s commitment to continuous improvement in care and services is the underpinning for the quality improvement program.
Goals
AlohaCare’s primary quality improvement goal is to improve members’ health status through a variety of activities implemented across all care settings and aimed at improving quality of care delivered and quality of services provided while promoting safe clinical practices.
Scope
The scope of AlohaCare’s quality improvement program is comprehensive and encompasses all clinical care and service aspects ces
- Availability of services
- Behavioral Health Services
- Clinical quality improvement
- Service quality improvement
- Member experience
- Practitioner experience
- Clinical practice guidelines
- Preventive health guidelines
- Continuity and coordination of care
- Patient safety
- Practitioner performance
- Effectiveness of the quality improvement program
Methods and Measures
AlohaCare’s Quality Improvement Program relies on both external and internal processes to measure quality. Outside organizations, such as NCQA, Medicare, HSAG and other agencies are measuring our performance based on National Standards, such as HEDIS, CAHPS, EQRO surveys and NCQA accreditation. Internally, we remain focused on providing superior service to our members, providers and other external partners. Our goal is to be viewed as the best MCO in Hawaii. We measure our success by reviewing and addressing complaints, grievances, quality of care reviews and appeals of our prior authorizations. We welcome comments on our performance in meeting all our Quality goals. Please send any comments to Performance Improvement Department at PeformanceImprovement@alohacare.org.
Clinical Practice Guidelines
AlohaCare uses evidence-based clinical practice guidelines developed by local and national associations. With the assistance of local physicians serving on our Medical and Behavioral Health Advisory Committees, the following guidelines have been adopted as minimum standards for AlohaCare providers.
- Adult Preventive Health (Adopted: 12/2/2002, recently revised: 8/4/2023)
- Management of Chronic Heart Failure (Adopted: 9/7/07, recently revised: 2/23/2024)
- Management of Chlamydia, (Adopted: 8/19/2011, recently revised: 2/23/2024)
- Coronary Artery Disease (CAD) (Adopted: 11/16/12, recently revised: 5/5/2023)
- Adult Immunizations (ages 19 years and older) (Adopted: 5/21/10, recently revised: 2/23/2024)
- Child/Adolescent Immunizations (ages 0-18 years) (Adopted: 5/21/10, recently revised: 2/23/2024)
- Diabetes Mellitus (Adopted: 12/20/2002, recently revised: 5/5/2023)
- Clinical Practice Guideline for the Diagnosis, Evaluation and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (Adopted: 5/21/2010, recently revised: 5/5/2023)
- Management of Asthma (Adopted: 12/20/2002, recently revised: 8/4/2023)
- Routine Prenatal and Postpartum Care (Adopted: 12/20/2002, recently revised: 8/4/2023)
- Treatment for Patients with MDD (Major Depressive Disorder)
- Chronic Obstructive Pulmonary Disease COPD (Adopted: 10/6/2017, recently revised: 2/23/2024)
- Hypertension
- Chronic Kidney Disease (CKD) (Adopted: 10/6/2017, recently revised: 8/4/2023)
Quality Improvement Program HEDIS
“HEDIS” is an acronym for the Healthcare Effectiveness Data and Information Set, which is a set of standardized measures designed by the National Committee for Quality Assurance (NCQA) to evaluate the performance of health plans. It allows for the assessment of health plans on the basis of quality and performance. Since its introduction in 1993, HEDIS has evolved to become the “gold standard” in managed care performance measurement.
AlohaCare is required to report the results of several HEDIS indicators annually to our State regulators, the Hawaii Department of Human Services (DHS), and our Federal regulators, the Center for Medicaid and Medicare Services (CMS). By measuring HEDIS indicators annually, we are able to evaluate our performance achievements, monitor our quality improvement efforts, and identify further opportunities for improvement in our health care delivery efforts.
Accreditations
AlohaCare’s commitment to quality and accountability was recognized when our AlohaCare plan for QUEST Integration members was awarded Health Plan Accreditation from NCQA. AlohaCare was measured against national standards and underwent a rigorous evaluation to earn the award. The NCQA accreditation process demonstrates a commitment to quality services and serves as a framework to improve business processes through benchmarking organizations against nationally recognized standards.
The National Committee for Quality Assurance (NCQA) is a not-for-profit organization dedicated to improving health care quality. NCQA has been driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda. It provides a symbol of excellence that is a reliable indicator that an organization is well-managed and delivers high quality care and service.