If you did not intend to leave our site, click or tap the "x" in the upper right-hand corner.
Collaborating to ensure quality care
Collaborating to ensure quality care
The New Jersey Department of Human Services, Division of Medical Assistance and Health Services (DMAHS) program requires Aetna Assure Premier Plus (HMO D-SNP) to have an ongoing quality assessment and performance improvement program to assess the quality of care that our members get. Then we use what we learn to adjust processes and operations and help members get the care they need.
Our quality assessment and performance improvement (QAPI) program has been established to improve the quality of care and promote an efficient use of medical resources to keep our members healthy. We focus on improving our members’ biological, psychological and social well-being.
Our aims
Meet all our members’ health care needs
Measure, monitor and improve clinical care and quality of service
Institute company-wide initiatives to improve the safety of our members and communities
Make sure we obey all the rules, whether they come from plan sponsors, federal and state regulators, or accrediting groups
What we do to improve our members' health care
Develop policies and procedures that reflect current standards of clinical practice
Review preventive and behavioral health services and how care is coordinated
Address racial and ethnic disparities in health care that could negatively impact quality health care
Monitor the effectiveness of our programs
Study the accessibility and availability of our network providers
Monitor the overuse and underuse of services by our Medicare members
Perform credentialing and recredentialing activities
Assess member and provider satisfaction
Model of care
Model of care
Our plan has developed a model of care (MOC) and a quality improvement plan to evaluate its effectiveness. The MOC is a plan for delivering care management and care coordination to:
Improve quality
Increase accessibility
Create affordability
Integrate and coordinate care across specialties
Provide seamless transitions of care
Improve use of preventive health services
Encourage appropriate use and cost effectiveness
Improve member health
Call us at 1-844-362-0934 (TTY: 711) if you have questions on our MOC plan and QAPI program.
HEDIS® tip sheets and billing guide
The HEDIS tip sheets and billing guide has information to help providers, their clinical
team and their billing staff improve HEDIS performance. If you have any questions
about HEDIS measures, you can call Provider Experience at 1-844-362-0934 (TTY: 711).
Or download the HEDIS tip sheets and billing guide below.
The Healthcare Effectiveness Data and Information Set (HEDIS) is a registered trademark of NCQA.