Commitment to Quality

Quality Improvement Program

We are committed to quality and to ensuring you get the best health care. We have created programs and services to meet the needs of our members and providers. Our quality improvement program is how we measure progress toward achieving the best care for our members. It looks at care, safety, and the services you get, so that we know where there are opportunities for improvement. This includes tests, shots and necessary care for diseases such as asthma, heart disease  and diabetes.

What our Efforts include
  • Our goal is to do better than what is expected from us.
  • We track health care services you get through a survey of our doctors called HEDIS®.
  • We ask how well we serve you through a member survey every year called CAHPS®.
What We Measure
  • Appointment availability
  • After-hours services
  • How long patients wait in the office for an appointment
  • Facility site reviews include looking at access for disabled people
  • Making sure the network of doctors in your area fits your needs
  • Member satisfaction surveys
  • Doctor satisfaction surveys
  • Quality of care studies to assure appropriate:
    • Well child visits
    • Immunizations
    • Cervical cancer screening
    • Breast cancer screening
    • Diabetes care
    • Asthma care
    • Cardiovascular care
    • High blood pressure 
    • Prenatal and postpartum care
Our 2015 Quality Improvement Goals
  • Improve quality of care
  • Monitor and improve patient safety
  • Improve member satisfaction
  • Ensure that care and communications are adjusted based on preferred language and cultural considerations
  • Improve the delivery of care for People with complex health care needs
  • Provide a network of high-quality providers and practitioners
  • Monitor and improve behavioral health care
  • Meet regulatory and other health plan requirements
  • Monitor quality of care in long-term care nursing facilities
  • Provide models of best care practices based on scientific evidence
How We Measure

We use a number of tools each year to help us determine how we’re doing. These include the Healthcare Effectiveness Data and Information Set (HEDIS®) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey.

HEDIS measures the quality of many types of care and service, and is used by nearly all American health plans. CAHPS is a survey that measures how happy members are with their doctors, their care and their health plan. We use these results to help us better our service.

HEDIS Summary Report - Medicaid

HEDIS Summary Report - L.A. Care Covered™

CAHPS Member Satisfaction Survey (Child) - Medicaid

CAHPS Member Satisfaction Survey (Adult) - Medicaid

CAHPS Member Satisfaction Survey - Medicare

Quality Improvement Program Descriptions

Providing an effective, system-wide, measureable plan for monitoring, evaluating and improving the quality of care and services:

2015 QI Program Description

Star Measures

Star ratings are used to compare Medicare Advantage and Prescription Drug Plans to help you make informed choices about your health care. Ratings focus on patient care and satisfaction, using national clinical and service-quality measures, health outcomes and patient feedback.

Star Measures Summary Report- Medicare

Nurse Advice Line

We offer free help from a nurse, at any time day or night. Get more information about the 24-hour nurse advice line.

Disease Management Program

L.A. Care Health Plan offers free disease management programs for asthma, diabetes, and heart disease. Learn more about our Disease Management Program.

Access to Care Standards
NCQA Accreditation

NCQA AccreditationL.A. Care is accredited by the National Committee for Quality Assurance (NCQA), an independent, non-profit organization which ensures excellence in health care across the nation. NCQA Accreditation is the most comprehensive evaluation of health plans in the nation, and is the only assessment program whose accreditation scores are based on actual results achieved on a set of clinical measures and consumer experience measures. NCQA-Accredited plans have a competitive advantage over non-accredited plans that includes respected, third-party validation of their quality and a detailed roadmap for continuous improvement that drives value.