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Quality Improvement Program Requirements __________________________________________________________
Hometown Health works to continuously improve the services offered to our members through our formal Quality Improvement Program . Federal and state regulatory agencies establish stringent quality standards for all health plans , and monitor to ensure that the plans and their providers meet these standards .
Hometown Health ’ s Quality Improvement Program provides the framework to ensure positive clinical outcomes and the optimization of member health , along with the formulation of strategies for improvement in non-clinical areas , such as improvement in customer service , improved claims reimbursement accuracy and timeliness , the enhancement of efficiencies , and the maximization of member satisfaction .
To meet these responsibilities , the Hometown Health Quality Improvement Department continually monitors specific quality indicators and activities within Hometown Health and among our providers .
The department ’ s activities include :
• Performing quality improvement studies , along with developing and implementing initiatives and programs designed to improve the quality of services provided to our members ;
• Monitoring member complaints for quality-of-care and service issues ;
• Coordinating member satisfaction surveys and other regulatory research ;
• Conducting medical record reviews ;
• Reporting quality-related information as required to regulatory agencies ; and
• URAC , HEDIS / STARs reporting and management .
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