QUALITY MANAGEMENT

CCMSO’s Quality Management department has a comprehensive and integrated Quality Management program.   It is designed to objectively and continuously monitor and evaluate the quality, appropriateness and outcome of health care delivered to members of the IPA’s.  The Quality Management department continuously pursues ways for improvement to ensure that our standards meet all criteria set forth by the Health Plans, governmental and regulatory agencies.  The Quality Management staff monitors the quality of care provided by the IPA’s and Medical Groups and conducts quality assessment studies.  Elements of the program include but are not limited to the following areas:

Quality Management functions include:

• Implementation of Quality Management Program and Work Plan
  
• Participation in Utilization Management Committee meetings
• Practice pattern profiling and analysis
• Quality management studies and reports required by health plans
• Preparation for and Participation in QM Delegation Audits conducted by health plans (if delegated for QM)
• Member complaints and grievances resolution
• Clinical provider complaints and grievances
  
• Other services as required by contracted health plans and regulatory agencies.
  

Quality Management Program is available to providers and members upon request.