AmeriHealth Caritas VIP Care Plus is committed to high-quality and coordinated health care services that meet members’ needs and improve health outcomes. We have created a Quality Assessment and Performance Improvement (QAPI) program to support this goal. The QAPI program aims to help members get effective, appropriate, and safe care, avoid preventable disease, manage chronic illnesses and disabilities, and maintain or improve health and quality of life. The program also looks for ways to make our services better.

QAPI Program Features and Scope

The QAPI program provides a structure and guidelines for medical and behavioral health care and non-clinical services available to our members. It utilizes a continuous cycle for assessing the quality of care and services to promote improvement. Coordinated improvement interventions occur in an integrated manner across a variety of departments, including but not limited to Medical Management, Pharmacy, Community Outreach, Member Services, Operations, Provider Network Management, Utilization Management, and Compliance. We evaluate our QAPI program each year.

The mission of AmeriHealth Caritas VIP Care Plus is to help people get care, stay well, and build healthy communities. The QAPI program supports this mission through the following:

• Leveraging health and disease management and education programs for members that help them manage their health in a manner that meets their cultural and language needs and preferences.
• Outreach to members using various methods to help them get the care and health education they need.
• Programs to serve our members who have special health care needs.
• Ensuring continuity and coordination of care.
• Collaboration with providers, community agencies, and regulatory agencies.
• Member and provider surveys and using the responses to improve our services.
• Reviewing quality of care concerns.
• Ensuring access to and availability of care and services.
• Continually assess the characteristics and needs of our members, including social determinants of health.
• Determine provider adherence to Clinical Practice Guidelines.

QAPI Program Strengths and Accomplishments 2024

HEDIS^® measures

HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Improvement noted in the following 

• Transitions of Care-Medication Reconciliation Post-Discharge (TRC-MRP)
• Annual Dental Visit (ADV)
• Controlling High Blood Pressure (CBP)
• Care for Older Adults (COA): Medication Review
• Care for Older Adults (COA): Pain Assessment
• Glycemic Status Assessment for Patients with Diabetes (GSD) (<= 9.0%)
• Kidney Health Evaluation for Patients with Diabetes (KED)

CAHPS® Survey Results

Improvement noted in the following CAHPS measures:

• Getting Needed Care
• Getting Appointments and Care Quickly
• Customer Service
• Care Coordination

Goals Met/Improvement Noted

• Improving Coordination of Care
• Improving Appropriate Utilization of Services

Reducing Health Care Disparities

A Health Equity and Culturally and Linguistically Appropriate Services (HECLAS) Committee was implemented in 2024. The plan continued participation in the Expanding Equity Project. The plan continued to collect and report enrollee race, ethnicity, and language data needed to address and decrease disparities in health care. The plan also ensured all enrollee mailings included appropriate translation instructions.

QAPI Program Priorities and Goals

In 2024, we remained committed to a seamless enrollee experience with adequate access to high-quality, coordinated care and services with the goal to decrease the burden of disease and improve health outcomes. We prioritized improving the health of our members and reducing health care disparities with our continuing efforts to:

• Improve performance measures through:
  • Monitoring access to care and services, including promotion of telehealth options.
  • Monitoring members’ compliance with health screenings and providers’ adherence to evidence-based Clinical Practice Guidelines.
  • Implementing programs to increase preventive health services.
  • Enhancing chronic disease management.
  • Expanding member and provider outreach initiatives.
• Strengthen our processes to address care gaps, including:
  • Maintaining effective care management.
  • Improving coordination and transition of care processes.
  • Improving communication and collaboration with providers.
  • Focusing on preventive care and early identification, including immunizations and cancer screenings.
  • Ensuring effective medication adherence and transitions of care programs.
• Continue to identify health care disparities and develop programs and activities to address barriers that contribute to the disparities.
• Improve member safety through ongoing monitoring and investigation of potential quality of care issues.

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