Quality Program Overview

The MediGold Quality Management (QM) program is a comprehensive program designed to comply with regulatory requirements to monitor the quality of care and services provided by the MediGold delivery system. This includes administrative activities of the Plan and its contracted providers.

The program’s purpose is to pursue opportunities for improving medical care, service and the well-being of MediGold members. The focus is on continuous quality improvement, with a constant eye on how care and services can be provided at a higher level of quality. Dedicated MediGold resources are allocated to conduct ongoing quality assessments of performance goals, along with problem resolution, as necessary.

A variety of activities are involved in implementing the MediGold QM program including, but not limited to, the following:

  • Risk management/quality concern reporting.
  • Monitoring of member service activities including complaints, appeals and grievances.
  • Healthcare Effectiveness Data and Information Set (HEDIS) data collection/monitoring.
  • Member satisfaction surveys.
  • Member-based performance improvement projects/studies.
  • Provider-based performance improvement.
  • Physician access and availability surveys.
  • Review of quality concerns for each physician at the time of recredentialing.
  • Required data reporting to the Centers for Medicare & Medicaid Services (CMS), such as hospital-acquired conditions and serious reportable adverse events.


You can find more details on Quality and Stars in our
Provider Administrative Manual.

 

 

Updated 03/2018