UM / QM Programs

Our objective is to ensure that utilization is appropriate, without evidence of over or under utilization, and that our activities measurably impact favorable health outcomes for the populations that we serve:

  • Network Medical Director for each specialty
  • Specialty Advisory Committee
  • Satisfaction Surveys (PCP, Specialist, Member)
  • Clinical Outcome Studies
  • Chart Reviews
  • Toll-free numbers for members and physicians
  • Concurrent review of medical records, surgical outcome studies, and encounter reporting
  • Ongoing analyses of access & availability

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