Quality Improvement Program

Program Overview

The Health Care Improvement (HCI) quality program provides a formal process to systematically measure and improve the Health Plan’s excellent quality ratings across all lines of business.   

The HCI program’s mission is to lead a dynamic and cross divisional quality program that demonstrates and drives excellence in quality and customer experience.  In strategic alignment with the Enterprise 7 Block Strategy, the HCI quality program has a specific focus on “improving member and community health.”  In addition to its quality focus, the program strives to achieve affordability and growth in all membership populations. 

Key regulatory elements of the HCI quality program include an organization-wide improvement strategy, program description, an annual evaluation of performance, and an annual Quality Improvement Program Action Plan.  To support improvement efforts, monthly measurement and reporting also exist to trend and forecast performance. 

Continued review of quality improvement activities requires ongoing:

  • Execution of member engagement tactics to close gaps in care and improve experience  
  • Alignment of affordability program development and risk adjustment efforts 
  • Coordination of value-based payment programs to drive quality measure improvement
  • Alignment with provider and community engagement activities 

For more information about the HCI quality program and our progress towards meeting our goals, contact us using the number on the back of your member card, or see the Annual QI Program SummaryOpen a PDF.

How to Report a Concern With Quality of Care Received

If you would like to report a concern with the quality of care you or your family received from doctors, hospitals, or other healthcare facilities, please let us know. The Health Plan investigates and tracks these issues. Please contact Customer Service by calling the phone number listed on your Member Card, or follow this link to email Customer Service email Customer Service.

How to Report Medical Misconduct

Examples of medical misconduct include (but are not limited to): practicing fraudulently, practicing with gross incompetence or gross negligence; practicing while impaired by alcohol, drugs, physical disability or mental disability; being convicted of a crime; filing a false report; guaranteeing that treatment will result in a cure; refusing to provide services because of race, creed, color or ethnicity; performing services not authorized by the patient; harassing, abusing or intimidating a patient; ordering excessive tests; and abandoning or neglecting a patient in need of immediate care.

The mission of the New York State Department of Health Office of Professional Medical Conduct is to protect the public through the investigation of professional discipline issues involving physicians and physician assistants. OPMC is responsible for investigating all complaints of misconduct, coordinating disciplinary hearings that may result from an investigation, monitoring physicians whose licenses have been restored after a temporary license surrender and monitoring physicians and physician assistants placed on probation as a result of disciplinary action.

If you feel that your doctor has committed misconduct, you should file a report with the Office of Professional Medical Conduct. Reports of misconduct are kept confidential.


GDPR Notification Content