Universal Health Care Quality Management Program Description

The UHC Quality Management Program is an organization wide, integrated program designed to improve the quality of care and service for UHC members. Primary responsibility is vested in the Medical Director and quality committees; however, all employees of the organization have a responsibility to promote quality improvement in clinical and service systems.

Quality Management Program Goals

The overall goal of the Quality Management Program is to improve care and services to members through application of continuous improvement processes. Consistent with its emphasis on quality, UHC maintains the Quality Management Program with the following goals:

• Effective care with an emphasis on patient safety;
• Efficient and effective resource utilization;
• Encouraging clinical efficiency;
• Health outcomes demonstrating coordinated, timely, and effective health care delivery that is focused on high volume high risk, acute and chronic conditions, and preventive health services;
• Systematic emphasis on continuous quality improvement (CQI) through targeted performance and outcome-based monitoring and evaluation;
• Member access to quality care that:
  • Improves and maintains the patient’s physical and emotional status,
  • Promotes early intervention, healthy outcomes and empowers members to develop and maintain healthy lifestyles,
  • Involves members in decision making,
  • Is based on accepted evidence-based medical principles, standards and practices,
  • Is accountable and responsive to member concerns and grievances,
  • Is accessible to members,
  • Emphasizes quality patient outcomes.
• Timely, appropriate, and effective management of member health, long-term care, and behavioral health needs, and coordination of medical and behavioral health care;
• Provision of quality services to members and providers with an emphasis on improving member satisfaction with health plan operations and providers;
• Responsive programs for the management of chronic diseases, disease prevention, and promoting health and wellness among members;
• Timely and convenient access to medical and behavioral health providers and health care services;
• An adequate scope of health care services that are geographically available to members;
• Member and provider satisfaction with health plan clinical and other services;
• Risk management that prevents, reduces, mitigates and manages clinical exposures of members and providers;
• Oversight of delegated managed care functions;
• Compliance with external accreditation, accountability, and regulatory standards.

Members and providers may request a hard-copy of the complete Quality Management Program by calling 1-866-690-4842 x 2989.