AlohaCare’s commitment to quality and accountability was recognized when our AlohaCare plan for QUEST members was awarded Health Plan Accreditation from URAC. AlohaCare was measured against national standards and underwent a rigorous evaluation to earn the award. The URAC accreditation process demonstrates a commitment to quality services and serves as a framework to improve business processes through benchmarking organizations against nationally recognized standards.
URAC, an independent, nonprofit organization, is well-known as a leader in promoting health care quality through its accreditation and certification programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the health care system. It provides a symbol of excellence for organizations to validate their commitment to quality and accountability. Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the entire health care industry.
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 (Updated 05/2012)
- Chronic Heart Failure (Updated 08/2013)
- Chlamydia (Updated 10/2013)
- Coronary Artery Disease (CAD) (Updated 08/2013)
- Adult Immunizations (Updated 08/2013)
- Child/Adolescent Immunizations (Updated 08/2013)
- Diabetes Mellitus (Updated 08//2013)
- Diagnosis and Treatment Management of Attention Deficit/Hyperactivity Disorder (ADHD) in School-Aged Children (Updated 10/2013)
- Management of Asthma (Updated 08/2013)
- Routine Prenatal and Postpartum Care (Updated 05/2012)
- Treatment for Patients with Major Depressive Disorder (Updated 10/2013)
“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.
1. Introduction to HEDIS
2. HEDIS Provider FAQs