Quality Assurance Activities and Programs
Upper Peninsula Health Plan (UPHP) MI Health Link wants you to receive the best possible care. We have a Quality Assessment and Improvement and Utilization Management Program Plan to ensure you get quality care. Our goal is that your care is:
- Cost effective
- Proven to promote and improve health
Our Program Plan is an ongoing process with goals for:
- Improving clinical data and processes – Evaluation to ensure that data collection is timely, accurate, and relevant to UPHP members, and that processes are in place to meet National Committee for Quality Assurance (NCQA), State of Michigan, and Federal regulatory compliance standards.
- Improving quality and safety of services and health outcomes for members – Evaluation of members’ health care against national or evidence-based standards. This allows UPHP to identify gaps in care and services that directly affect safety and health outcomes. Examples of services that are evaluated are flu shots, diabetes care, screening tests, and preventive care visits.
- Assuring appropriate utilization of health care services – Evaluation of medical necessity and cost effectiveness of health care services delivered to members, using accepted and standardized utilization criteria to screen for benefit coverage and medical necessity.
- Improving member and provider satisfaction – Evaluation of members’ and providers’ satisfaction with care through surveys and by tracking complaints and grievances. One type of survey is called CAHPS (Consumer Assessment of Healthcare Providers and Systems). This tells UPHP if you are happy with your care and your provider. It also tells UPHP what we can make better for you. This might be getting your appointment faster or having more providers to take care of you.
Evaluation of the UPHP Quality Improvement and Utilization Management Program Plan and the Model of Care is done at least annually by the UPHP Service Advisory Committee and the UPHP Clinical Advisory Committee.
They evaluate the program effectiveness, compare UPHP activities to the program goals and objectives, and evaluate how the quality of clinical care and services to members was impacted. The program plan is updated based on the committees’ findings and recommendations.
To learn more about our Quality Assessment and Improvement and Utilization Management Program Plan, call UPHP Customer Service at 1-877-349-9324 (TTY: 711) seven days a week from 8 a.m. to 9 p.m. Eastern time. The call is free.H1977_001_GP_20WP
Page Last Updated: 09/20/2018
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