About the Program
The Quality Improvement and Health Equity (QIHE) program is an evolving program responsive to the changing needs of our members and practitioners. Every year, L.A. Care assesses its QIHE program to identify opportunities for improvement, implement appropriate interventions, and assist you in improving your patients' health.
QIHE is designed to meet the specific needs of L.A. Care members. L.A. Care conducts surveys, studies and focus groups to assess strengths, weaknesses and opportunities to improve clinical care, access to care, and member and practitioner satisfaction.
QIHE provides an effective, system-wide, measurable plan for monitoring, evaluating and improving the quality of care and services. Learn more us by reading our:
2024 Quality Improvement Program Description
Clinical Care and Patient Experience Initiatives for 2025
2023 Quality Improvement & Health Equity Program Annual Report and Evaluation
If you have any questions or concerns about the health plan, call L.A. Care's Member Service Department.
If you would like a paper copy of this notice, please message the Quality Improvement Department of L.A. Care.
The Quality Improvement Goals are:
- Improve the quality of care
- Improve Health Equity
- Improve the delivery of care for persons with complex healthcare needs
- Improve member satisfaction
- Meet regulatory and other health plan requirements
- Monitor and improve patient safety
- Monitor and improve behavioral healthcare
- Monitor Quality of Care in Long Term Care Nursing Facilities and Community-Based Adult Services (CBAS) Facilities
- Provide Health Education Programs, Services, and Resources
- Provide culturally linguistically appropriate services
- Provide a network of high-quality providers and practitioners
- Provide an evidence-based model of care
- Provide Continuous Improvement of Quality of Care Model of Care (MOC)
Some of the things we measure include:
- Appointment availability
- After-hours services
- How long do patients wait in the office for an appointment
- Facility site review, which includes looking at access for disabled people
- Making sure the network of doctors in your area fits your needs
- Member satisfaction
- Doctor satisfaction
- Quality of care studies to ensure appropriate:
- Well child visits
- Immunizations
- Cervical cancer screening
- Breast cancer screening
- Diabetes care
- Asthma care
- High blood pressure
- Prenatal and postpartum care
- Cholesterol management
Network practitioners play a prominent role in the QIHE Program.
L.A. Care actively solicits practitioners to become involved in QIHE activities through participation in QIHE, Credentialing, and Utilization Management committees, expert participation in peer review, and other QIHE collaborative activities. The QIHE program strives to improve equity and quality of care and services to members and to support the practitioner-patient relationship.
If you are interested in participating in any of our QIHE activities, such as committees, please message the Quality Improvement Department of L.A. Care.
Quality Measurement
National Committee for Quality Assurance (NCQA)
L.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.
L.A. Care has achieved NCQA Health Plan (HP) Accreditation since 2014. For 2024, L.A. Care earned this accreditation for its Medi-Cal (3.5 stars), Medicare Plus (Dual-Special Needs Plan [D-SNP] - 3 stars), and L.A. Care Covered lines of business. Additionally, L.A. Care earned the NCQA Health Equity Accreditation.
We use several tools each year to help us determine how we are doing. These include the Healthcare Effectiveness Data and Information Set (HEDIS®) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey. These measure the quality of care and service and show us where we can focus on 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, care, and plan. We use these results to help us improve our service.
Star ratings are used to compare Medicare Advantage and Prescription Drug Plans in helping patients make informed choices regarding their health care. Ratings emphasize patient care and satisfaction, using national clinical and service-quality measures, health outcomes and patient feedback.
Additional Resources
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.
The Quality Improvement Program hosts monthly provider webinars on popular topics.
The Nurse Advice Line (NAL) is a service provided by L.A. Care free of charge intended to give Members general health information, education, and advice and to assist Members in taking a more informed role in decisions regarding their health care options. Visit our NAL web page for more information about the 24 hour nurse advice line.
L.A. Care Health Plan monitors practitioner network availability and accessibility and telephone access to member services annually. L.A. Care, The California Department of Managed Health Care (DMHC) and the California Department of Health Care Services (DHCS) have established quantifiable standards for both the number and geographic distribution of practitioners and driving distances to pharmacies and access standards for services.
L.A. Care uses guidelines to ensure that its members have access to care:
We have HEDIS® (Healthcare Effectiveness Data and Information Set) reference guides for selected priority measures. These guides are designed to help your practice provide the best quality care, in alignment with the HEDIS® standards as well as with evidence-based clinical practice guidelines.