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 send a message to the Quality Improvement Department of L.A. Care.
Quality Improvement Program
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.
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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.
If you are interested in participating in any of our QI activates, such as, committees, please message the Quality Improvement Department of L.A. Care.
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 conducts 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 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 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 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 and Community Based Adult Services (CBAS) Facilities
- Provide evidence based model of care
Quality Improvement Activities
Quality Improvement Program Descriptions
Providing an effective, system-wide, measureable plan for monitoring, evaluating and improving the quality of care and services:
Accreditation
National Committee for Quality Assurance (NCQA)
In 2020, L.A. Care earned the NCQA Health Plan (HP) Accreditation for its Medi-Cal, Cal MediConnect (CMC), and L.A. Care Covered (LACC) lines of business.
Additionally, L.A. Care earned the 2021 NCQA Multicultural Health Care Distinction (MHC), this is L.A. Care’s 5th consecutive Distinction, it was first awarded in 2013 and has since successfully earned this distinction every two years.
For these awards, NCQA evaluated L.A. Care’s work to reduce health care disparities, network adequacy and consumer protection, the organization ability to collect Race/Ethnicity/Language (REL) data, and provide language assistance to members.
Earning the Health Plan Accreditation (HP) and the Multicultural Health Care Distinction (MHC) from NCQA is important for L.A. Care as it demonstrates L.A Care’s commitment to quality improvement that translates to optimum levels of health services to our members while also tailoring these services to our members’ cultural and languages preferences.
Annual Evaluation
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 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.
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.
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) 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:
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.
Quality Improvement Provider Trainings
The Quality Improvement Program hosts monthly provider webinars on popular topics.