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Quality management program

At Aetna Assure Premier Plus (HMO D-SNP), we take care of the whole member. We’re dedicated to giving them the best health care experience possible. Our quality management team works with providers to make sure members get the care they need.

Do you have a question?

You can call Provider Services anytime at 1-844-362-0934 (TTY: 711).

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.

Also of interest: