QM Program
Our goal at Optimum HealthCare is to help our members improve their health by providing the best care and service options. To do this, we rely on our Quality Management (QM) program to monitor the quality of care given by Plan providers. The QM Program also looks for areas of service that need to be improved.
Measuring Success
Every year, we measure to see the progress we have made toward meeting our goals for healthy members. One of the tools we use to do this is called HEDIS®, which stands for Healthcare Effectiveness Data and Information Set. HEDIS® is a very common tool used by health care plans to see how well they are serving their members. We use these HEDIS® results to see where we need to focus our improvement efforts.
HEDIS® Results
Our HEDIS® MY 2024 results show that Optimum HealthCare improved its performance and met quality goals in many HEDIS® measures. These areas include:
- Breast Cancer Screening
- Colorectal Cancer Screening
- Controlling High Blood Pressure
- Eye Exam in Patients with Diabetes
- Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions
- Glycemic Status Assessment for Patients with Diabetes
- Kidney Health Evaluation for Patients with Diabetes
- Osteoporosis Management in Women Who Had a Fracture
- Transition of Care: Medication Reconciliation Post-Discharge
Areas where we would like to improve our performance include:
- Statin Therapy for Patients with Cardiovascular Disease
- Transitions of Care: Notification of Inpatient Admission
- Transitions of Care: Patient Engagement
- Transitions of Care: Receipt of Discharge Information
View our full quality Health Plan Report Card.
Additional information HEDIS® and Performance Measurement.
You can also call Member Services at 1-866-245-5360.