AlohaCare’s commitment to quality and accountability was recognized when our AlohaCare plan for QUEST Integration members was awarded Health Plan Accreditation from NCQA. AlohaCare was measured against national standards and underwent a rigorous evaluation to earn the award. The NCQA accreditation process demonstrates a commitment to quality services and serves as a framework to improve business processes through benchmarking organizations against nationally recognized standards.
The National Committee for Quality Assurance (NCQA) is a not-for-profit organization dedicated to improving health care quality. NCQA has been driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda. It provides a symbol of excellence that is a reliable indicator that an organization is well-managed and delivers high quality care and service.
Clinical Practice Guidelines
AlohaCare uses evidence-based clinical practice guidelines developed by local and national associations. With the assistance of local physicians serving on our Medical and Behavioral Health Advisory Committees, the following guidelines have been adopted as minimum standards for AlohaCare providers.
- Adult Preventive Health (Adopted: 12/2/02, recently revised: 2/27/17)
- Chronic Heart Failure (Adopted: 9/7/07, recently revised: 11/20/15)
- Chlamydia (Adopted: 8/19/11, recently revised: 11/20/15)
- Coronary Artery Disease (CAD) (Adopted: 11/16/12, recently revised: 10/6/17)
- Adult Immunizations (Adopted: 5/21/10, recently revised: 11/20/15)
- Child/Adolescent Immunizations (Adopted: 5/21/10, recently revised: 11/20/15)
- Diabetes Mellitus (Adopted: 12/20/02, recently revised: 10/6/17)
- Diagnosis and Treatment Management of Attention Deficit/Hyperactivity Disorder (ADHD) in School-Aged Children (Adopted: 5/21/10, recently revised: 10/6/2017)
- Management of Asthma (Adopted: 12/20/02, recently revised: 10/6/17)
- Routine Prenatal and Postpartum Care (Adopted: 12/20/02, recently revised: 2/27/17)
- Treatment for Patients with Major Depressive Disorder (Adopted: 3/21/03, recently revised: 10/6/17)
- COPD (Chronic Obstructive Pulmonary Disease) (Adopted: 10/6/17)
- Hypertension (Adopted: 10/6/17)
- Chronic Kidney Disease (CKD) (Adopted: 10/6/17)
“HEDIS” is an acronym for the Healthcare Effectiveness Data and Information Set, which is a set of standardized measures designed by the National Committee for Quality Assurance (NCQA) to evaluate the performance of health plans. It allows for the assessment of health plans on the basis of quality and performance. Since its introduction in 1993, HEDIS has evolved to become the “gold standard” in managed care performance measurement.
AlohaCare is required to report the results of several HEDIS indicators annually to our State regulators, the Hawaii Department of Human Services (DHS), and our Federal regulators, the Center for Medicaid and Medicare Services (CMS). By measuring HEDIS indicators annually, we are able to evaluate our performance achievements, monitor our quality improvement efforts, and identify further opportunities for improvement in our health care delivery efforts.
- Introduction to HEDIS
- HEDIS Provider FAQs
Quality Improvement Program
AlohaCare's Quality Improvement Program focuses on high quality relationships with members and providers. We are committed to improving care and services for our members.
Click here to learn more.
Quality Improvement Incentive Program (P4P)
Click here to learn more about AlohaCare's 2015 Quality Improvement Incentive Program.