Quality
Overview
'Ohana Health Plan’s Quality Improvement (QI) Program monitors and evaluates the quality, appropriateness, accessibility and availability of health care services.
Medical Records
QI may conduct annual medical record audits in physician offices. Patient records are reviewed for evidence that care and screenings have been documented. Complete information is available in the Medicaid or Medicare Advantage provider manuals.
Clinical Practice Guidelines
CPGs outline medical standards of care and best practices.
HEDIS®*
HEDIS® is a mandatory process that occurs annually. We've developed this toolkit to help identify required preventive services.
New: HEDIS Measurement Year 2021 Toolkit
- Quick Reference Guide - English (PDF)
- Adult Pocket Guide - English (PDF)
- Pediatric Pocket Guide - English (PDF)
- Pediatric Preventive Health Counseling Form - English (PDF)
HEDIS Measurement Year 2020 Toolkit
- Adult At-A-Glance Guide - English (PDF)
- Adult Coordination of Care Letter - English (PDF)
- Adult Pocket Guide - English (PDF)
- How to Code for a Well Visit with a Sick Visit - English (PDF)
- Pediatric At-A-Glance - English (PDF)
- Pediatric Preventive Health Counseling Form - English (PDF)
- Pediatric Pocket Guide - English (PDF)
- ESPDT Toolkit Guide - English (PDF)
- Women's Health Measures At-A-Glance Guide - English (PDF)
Other Resources
Helpful Information
EPSDT Program
Sign in to our secure Provider Portal to find out which eligible members are due for EPSDT screenings. If you haven't registered on our site, please join today. Preventive pediatric health care guidelines for children are located in our clinical practice guidelines.
Provider Participation
Network providers are contractually required to cooperate with quality improvement activities. Providers are also invited to volunteer for the QI Program. Please contact us if you're interested in volunteering.