Quality
CoxHealth Medicare Advantage
Programs
Quality Improvement Program
The Cox HealthPlans (CHP) Medicare Advantage (MA) Quality Improvement Program provides a formal process to objectively and systematically monitor and evaluate the quality, appropriateness, efficiency, safety, and effectiveness of care and service for CHP MA plan members. The program also sets forth a structured approach for conducting delegation oversight and monitoring compliance with CMS, State of Missouri and Federal Marketplace requirements. The program focuses on identifying and implementing opportunities for improving operational processes as well as health outcomes and satisfaction of MA members and practitioners/providers.
Quality Improvement Program information and activities are shared regularly with CHP employees, members, and providers through blogs, website posting, flyers, and other forms of communication as needed. The program includes an Annual Quality Improvement Evaluation, Quality Improvement Initiatives and Chronic Care Improvement Program that are designed to improve member health.
Medical Management Program
The CHP MA Medical Management Program is designed to partner with MA members to help them improve their health while utilizing appropriate medical services at the lowest cost. CHP and CoxHealth provide members with the knowledge and information needed to make informed care decisions that will maximize plan benefits and ultimately result in higher level of quality. The program allows the combining of medical claims, pharmacy claims, health records and enrollment data with the health system’s clinical resources, creating a comprehensive approach to identification, outreach and targeted care for our members. Unlike other standard medical management programs that only use claims data, our program integrates and coordinates all health system resources for our members. All CHP MA members are eligible for MA medical management.
Medical Management Program information and activities are shared regularly with CHP employees, members, and providers through blog, website posting, flyers, and other forms of communication as needed.
Risk Management Program
The purpose of CHP’s MA Risk Management Program is to protect MA members, staff members and visitors from inadvertent injury. It is designed to provide guidance and structure for the organization’s clinical and business services that drive quality member care while fostering a safe environment. The focus of the risk management program is to provide an ongoing, comprehensive, and systematic approach to reducing risk exposures. Risk management activities include identifying, investigating, analyzing, and evaluating risks, followed by selecting and implementing the most appropriate methods for correcting, reducing, managing, and/or eliminating them.
Risk Management Program information and activities are shared regularly with CHP employees, members, and providers through blog, website posting, flyers, and other forms of communication as needed.
Member Satisfaction
Your satisfaction is so important to us at CHP! Each year we conduct a Member Satisfaction Survey to gauge our level of meeting member needs and finding out where pain points exist. More information will be posted in the blog for details near the survey time. After the survey is complete, CHP will share the results internally with the health plan team and externally with our members through our member blog.
Behavioral Health
CHP wants to make behavioral health care easy and convenient for members to access. Through setting standards to care and using Integrated Behavioral Health in some CoxHealth clinics, we are knocking down barriers and opening avenues for our members to receive the care they need.
Behavioral Health Access Standards
- Routine care within 10 business days
- Urgent care within 48 hours
- Non-life-threatening emergency care within 6 hours
- Life-threatening emergency care 24 hours/7 days per week
CoxHealth Integrated Behavioral Health
- Offering professional mental health care services at certain primary care locations
- Follow this link to learn more about the program and how it could benefit you
CoxHealth Plans Access to Care Standards
Preventive Health Guidelines
U.S. Preventive Services Task Force A and B Recommendations under the Affordable Care Act
You can also view preventive service information for the following categories on HealthCare.gov:
Clinical Practice Guidelines
CHP expects our network providers to deliver excellent care and follow national standards in their practice.
Diabetes
Hypertension
- 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults, Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8), American Medical Association (AMA)
Asthma
- National Heart, Lung and Blood Institute, Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma, Full Report 2020
COPD
- American College of Physicians (ACP) Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease: A Clinical Practice Guideline Update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society and European Respiratory Society
Depression Screening
Advance Directives
CHP encourages every member to complete an Advance Medical Directive. These forms offer peace of mind for your future medical care. You can find more information, including forms and directions, at this page on the CoxHealth website.
Cox HealthPlans (CHP) strives to give members the best quality health plan and prioritize informing members about committees, projects, and results of our activities.
