Quality Improvement (QI) Program

We are committed to the provision of a well-designed and well-implemented Quality Improvement (QI) Program. Our culture, systems, and processes are structured around this mission to improve the health of all enrolled members.

Goals and Objectives

Our primary QI goal is to ensure that Absolute Total Care's members have access to the highest quality of health care services that is responsive to their health needs and able to improve their health outcomes.

Scope

The scope of the QI Program is comprehensive and addresses both the quality and safety of clinical care and quality of service provided to Absolute Total Care's members. We incorporate all demographic groups, benefit packages, care settings, and services in QI activities, including preventive care, emergency care, primary care, specialty care, acute care, short-term care, long-term care (depending upon Absolute Total Care's products), and ancillary services.

Absolute Total Care's QI Program monitors the following:

Acute and chronic care management
Behavioral health care services
Clinical quality initiatives
Compliance with member confidentiality laws and regulation
Compliance with preventive health and clinical practice guidelines
Continuity and coordination of care
Delegated entity oversight
Department performance and service
Member and provider cultural competency
Member enrollment and disenrollment
Member grievance and appeal system
Member satisfaction
Patient safety
Medical record documentation
Pharmacy services
Provider and Absolute Total Care after-hours telephone accessibility
Provider appointment availability and accessibility
Provider network adequacy and capacity
Provider satisfaction
Quality of care review
Selection and retention of providers (credentialing and recredentialing)
Utilization management, including under- and over-utilization

Credentialing Standards

For consideration to participate in the Absolute Total Care network, all licensed physicians and other licensed healthcare professionals who have an independent relationship with Absolute Total Care must complete an application for participation and submit copies of applicable supporting documentation.

Culturally and Linguistically Appropriate Services (CLAS) Program

Absolute Total Care is committed to establishing multicultural principles and practices throughout its organizational systems of services and programs. That mission is supported by facilitating the process by which Absolute Total Care can respond to the healthcare needs of all individuals, regardless of their ethnic, cultural, religious beliefs, or language. Our Culturally and Linguistically Appropriate Services (CLAS) program is reviewed and updated annually. To view our current CLAS program, please view the Culturally and Linguistically Appropriate Services (CLAS) (PDF).

QI Program Participation

Absolute Total Care requires providers and practitioners to cooperate with all QI activities as well as allow the use of provider and/or practitioner performance data to ensure the success of the QI Program. More information about the Absolute Total Care QI Program is outlined below. You can also call Provider Services at 1-866-433-6041 and ask to speak with the Quality Improvement Department.