QUALITY IMPROVEMENT PROGRAM
One of the highest priorities at GlobalHealth is to provide our members and providers with outstanding care and assistance. To accomplish this goal, GlobalHealth’s Quality Department formed a cross functional team to developed a Quality Improvement (QI) Program that meets these needs. The QI Program is designed to recognize areas of improvement throughout the organization and when needed implement corrective action plans addressing identified issues. The QI Program also focuses on the importance of preventative health screenings by educating providers and members.
Annually, the GlobalHealth Quality Improvement Program is updated to reflect changes in the industry and is presented to the GlobalHealth Quality Improvement Committee (QIC) for review and approval. The QIC consists of members from the Credentialing, Care Management, Customer Care, Pharmacy and Provider Relations departments. Meeting on a regular basis, the committee reviews all areas of the company and, if necessary, establishes corrective action plans to address areas of concern. A QI Work Plan is also developed to encompasses not only targeted areas requiring improvement, but also regular monitoring of areas that are on-track to ascertain GlobalHealth’s ever-present commitment to offering quality care to its members.
To show our commitment to quality, GlobalHealth is accredited by the National Committee for Quality Assurance (NCQA). As part of that accreditation, GlobalHealth annually participates in the NCQA Healthcare Effectiveness Data and Information Set (HEDIS®) audit and the NCQA Commercial and Medicare versions of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey. The information gathered through these audits and surveys provides quality indicators that affirm GlobalHealth’s pledge to always strive to provide the best care possible through continual improvement.
For our Medicare health plans, we participate in the CMS Medicare Quality Star Rating System that incorporates quality measures from HEDIS®, CAHPS®, Medicare Health Outcome (HOS) survey, medication adherence, appeals and grievances, complaints and other plan administrative measures. Our goal is to operate our health plans at a 5 Star rating to make sure that we are providing our members with the highest quality of care and service.
The GlobalHealth Quality Improvement Program and GlobalHealth Quality Improvement Plan are made available to members and providers upon request from:
All information is reviewed by the Network Adequacy Committee prior to a contract being offered. The committee meets quarterly.