Quality Improvement
Quality Improvement Program
We are committed to the provision of a well-designed and well-implemented Quality Improvement (QI) program. Our culture, systems, and processes are structured around this mission to improve the health of all enrolled members.
Scope
The scope of the QI Program is comprehensive and addresses both the quality and safety of clinical care and quality of services provided to Health Net's members including medical, behavioral health, dental, and vision care. We incorporate all demographic groups, care settings, and services in QI activities, including preventive care, emergency care, primary care, specialty care, acute care, short-term care, long-term care (depending upon Health Net's products), and ancillary services.
Goals & Objectives
Our primary quality improvement goal is to improve members’ health status through a variety of meaningful quality improvement activities implemented across all care settings and aimed at improving quality of care and services delivered.
Providing Quality Care
As our valued provider, your ability to service our members is important. Health Net of Oregon is here with information to help you provide the very best care. This information is part of our Quality Improvement (QI) program designed to address both the quality and safety of services provided to your patients and our members.
CAHPS Survey
The CAHPS® (Consumer Assessment of Healthcare Providers and Systems) is an annual survey, mandated by the Centers for Medicare & Medicaid Services (CMS), that asks patients about their experiences and satisfaction with their healthcare system, including their providers.
Provider Satisfaction Survey
You are essential to providing the highest-quality healthcare possible for our members, and your satisfaction is important to us, too. We assess your experience with the health plan through an annual Provider Satisfaction Survey. These survey results will be reviewed by Health Net of Oregon and will be key to helping us improve the provider experience, so please be sure to complete the survey. Your feedback informs improvement opportunities and quality initiatives.
Provider Directory and Continued Access to Care
If your address or telephone number changes, or if you can no longer accept new patients or are leaving the network, please notify Health Net of Oregon as soon as possible so we can update our Provider Directory. Having access to accurate provider information is vitally important to our members, and we want to work together to ensure continuity of care can be maintained for Health Net of Oregon Health Plan members.
Utilization Management
Utilization Management (UM) decisions are based only on the appropriateness of care and service and the existence of coverage. Health Net of Oregon does not reward providers, practitioners, or other individuals for issuing denials of coverage or care and does not have financial incentives in place that encourage decisions resulting in underutilization. Denials are based on lack of medical necessity or lack of covered benefit. Nationally recognized criteria (such as lnterQual or MCG) are used if available for the specific service request, with additional criteria (e.g., clinical/medical policies) developed internally through a process that includes a review of scientific evidence and input from relevant specialists. For more information, see Pre-Auth Check and Clinical Practice Guidelines.
Transition to Other Care
Providing quality care to our members includes helping adolescents transition to an adult care provider. If you or one of your patients need assistance in finding an adult primary care provider or specialist, contact Health Net of Oregon. We can assist in locating an in-network adult care provider or arranging care if needed.
Language and Interpreter Services
Together, we must make language assistance services available to people who prefer a Language other than English (LOE) at all points of contact during all hours of operation and at no cost to our members. We are here to help get language assistance to Health Net of Oregon members and providers without unreasonable delay at all vital points of contact.