Quality assurance

The Illinois Department of Healthcare and Family Services (HFS) requires Aetna Better Health Premier Plan MMAI to have an ongoing quality assessment and performance improvement program that assesses the quality of care and adjusts processes and operations to improve the quality of care provided to members.

Aetna Better Health Premier Plan MMAI works in partnership with providers to continuously improve the care given to our members.

Aetna Better Health Premier Plan MMAI’s Quality Assessment and Performance Improvement (QAPI) program has been established to improve health care quality, and to promote appropriate, cost-effective use of medical resources and positive health outcomes for our members. We focus on improving our members’ biological, psychological and social well-being.

Through our Quality Management (QM) department, we collect meaningful data, identify root causes, develop appropriate solutions, and implement plans to provide better health care. These improvements can occur at the individual level or system-wide.

Our QM department works in partnership with providers to continuously improve the care given to our members. It includes the following areas:

The quality of care review unit monitors the quality of care provided by the network, as well as the review and resolution of issues related to the quality of health care services provided to members.

The prevention and wellness unit is responsible for quality improvement activities and clinical studies using data collected from providers and encounters.

The credentialing unit is responsible for provider credentialing activities.

The special needs unit is responsible for coordination and liaison with acute care behavioral health services.

This department is responsible for development of practice guidelines and policies related to quality management. Whenever possible, we adopt practice guidelines from national organizations known for their expertise in the area of concern. To review these guidelines, view the provider handbook.