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.

HEDIS Measurement Year 2022 Toolkit

• Quick Reference Guide - English (PDF)
• Behavioral Health Measures At-a-Glance - English (PDF)
• Preventive Health Counseling and Education Form - Children and Adolescents - English (PDF)
• Adult Pocket Guide - English (PDF)
• Pediatric Pocket Guide - English (PDF)

HEDIS Measurement Year 2021 Toolkit

• Quick Reference Guide - English (PDF)
• Adult Pocket Guide - English (PDF)
• Pediatric Pocket Guide - English (PDF)
• Preventive Health Counseling and Education Form for Children and Adolescents - English (PDF)

Other Resources

• 2023 Prior Authorization Form - English (PDF)
• PHQ9 Guidence for Depression Assessment Flyer 2023 (PDF)
• Antidepressant Adherence 2023 (PDF)
• Antipsychotic HEDIS Measures 2023 (PDF)
• Chlamydia Screening 2023 (PDF)
• Controlling High Blood Pressure Flyer (PDF)
• Improving Patient Engagement 2023 (PDF)
• Initiation and Engagement of Alcohol and Drug Treatment (IET) (PDF)
• Pediatric TB Risk Assessment Questionnaire (PDF)

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.