Commitment to Quality

The Quality Improvement program is an evolving program that is responsive to the changing needs of our members and practitioners. Every year, L.A. Care assesses its QI program to identify opportunities for improvement, implement appropriate interventions, and assist you in improving your patients' health.

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. 

Network Practitioners

Network practitioners play a prominent role in the QI Program. 

L.A. Care actively solicits practitioners to become involved in QI activities through participation on QI, Credentialing, and Utilization Management committees, expert participation in peer review, and other QI collaborative activities. The QI program strives to improve quality of care and service to members and to support the practitioner-patient relationship.

Highlights of QI Activities

Highlights of QI activities designed to evaluate and improve the quality of health care for members.

The Quality Improvement Program is designed to meet the specific needs of L.A. Care members. L.A Care conducted surveys, studies and focus groups to assess strengths, weaknesses and opportunities to improve clinical care, access to care, and member and practitioner satisfaction.

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 2018 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
  • Community Based Adult Services Facilities
Quality Improvement Program Descriptions

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

2018 Quality Improvement Program Description

HEDIS & CAHPS - Measuring Performance

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 service and show us where we can focus for improvement. 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 patients are with their doctors, their care and their plan. We use these results to help us improve our service.

Star Measures

Star ratings are used to compare Medicare Advantage and Prescription Drug Plans in helping you make informed choices regarding your health care. Ratings emphasize 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. Click here for 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. 

Access to Care
L.A. Care Health Plan monitors practitioner network availability and accessibility and telephone access to member services on an annual basis. L.A. Care, along with the California Department of Managed Health Care (DMHC) and California Department of Health Care Services (DHCS) has established quantifiable standards for both the number and geographic distribution of practitioners and drive distances to pharmacies and access standards for services.
L.A. Care uses guidelines to ensure that its members have access to care:

Access to Care Standards

Clinical Practice and Preventive Health Guidelines

L.A. Care maintains processes to ensure that healthcare is delivered according to professionally recognized standards of care. For selected treatment most relevant to the insured population, L.A. Care adopts and disseminates Clinical Practice and Preventive Health Guidelines sponsored by government and non-government organizations.

You can find these helpful guidelines by visiting our Clinical Practice and Preventive Health Guidelines page.