Quality Improvement Program

We are committed to quality. This leads us to create programs and services to meet the needs of our members and providers. L.A. Care wants to make sure you are getting the best health care. This is called Quality Improvement. Each year the quality improvement program looks at care, safety, and the services you get. This tells us what we are doing well or may need to change. This is also a way to measure our progress toward making sure you are getting the best health care. The program helps you get better and/or stay healthy by helping you get needed tests, shots, and needed care for diseases such as asthma, heart disease, and diabetes. You can see some of our results on the links provided.
 

Here are some of our efforts to make sure you get the best health care: 

  • Our goal is to do better than what is expected from us.
  • We track the health care services that 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®.

Each year, we make changes to improve the health care you get by starting new projects.

Content CTA: 
What We Measure

Some of the things we measure include:

  • Appointment availability
  • After-hours services
  • How long patients wait in the office for an appointment
  • Facility site reviews includes 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
    • High Blood pressure 
    • Prenatal and postpartum care
    • Cholesterol management

Quality Improvement Goals

The 2016 Quality Improvement Goals are:

  • Improve Quality of Care
  • Monitor and Improve Patient Safety
  • Improve Member Satisfaction
  • Provide Culturally Linguistically Appropriate Services
  • Improve the Delivery of Care for Persons with Complex Health Care Needs
  • Provide a Network of High Quality Providers and Practitioners
  • Monitor and Improve Behavioral Healthcare
  • Meet Regulatory and Other Health Plan Requirements
  • Monitor Quality of Care in Long Term Care Nursing Facilities
  • Provide Evidence Based Model of Care
Quality Improvement Program Descriptions

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

2016 QI Program Description

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.

These measure quality of care and services and show us where to focus. 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™

HEDIS Summary Report - Cal MediConnect
 

L.A. Care takes your concerns seriously. We want to give you and your family the best care and services.
 

CAHPS Member Satisfaction Survey (Child) - Medicaid

CAHPS Member Satisfaction Survey (Adult) - Medicaid

CAHPS Member Satisfaction Survey - Cal MediConnect

CAHPS Member Satisfaction Survey - L.A. Care Covered

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.

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. Please visit our Disease Management Program page to learn more about each program.

Access to Care Standards

L.A. Care uses guidelines to make sure that its members have access to care:
 

Access to Care Standards

If you have any questions about the health plan, call L.A. Care's Member Service Department.
If you would like a paper copy of this notice, please call the Quality Improvement Department of L.A. Care at 1-213-694-1250 x4027