The department monitors the care provided to hospitalized members as well as the care members receive in physicians' offices. Complaints relating to quality of care are forwarded to this department for action, and each complaint is thoroughly investigated and tracked. He or she receives a copy of the medical record in question with all member and physician names removed and is asked to provide an impartial opinion. If a potential issue is identified, the case is presented to the Peer Review Committee for final determination.
Corrective action is taken as needed, and all issues are recorded and monitored.
They must be clearly written and must contain appropriate documentation of the care the physician is providing. Suggestions for improvement are given to physicians as needed, and follow-up is conducted to be sure the records meet the standard criteria. In addition to reviewing our participating providers for quality of care, the QI department also monitors preventive and clinical care to make sure you are receiving the necessary care to keep you healthy. When an opportunity for improvement is identified, we contact you, either individually or through our newsletters, to encourage you to use our services. The QI department has targeted immunizations as an area in need of improvement.