Quality Improvement (QI) Program
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 2025 Toolkit
HEDIS® Measurement Year 2024 Toolkit
Additional Resources
Quality Measures
- 2023 Prior Authorization Form (PDF)
- Follow-Up Care for Children Prescribed ADHD Medication (PDF)
- Antidepressant Adherence (PDF)
- Antipsychotic HEDIS Measures (PDF)
- Antipsychotic and Antidepressant Medication Adherence (PDF)
- Chlamydia Screening (PDF)
- PHQ9 Guidence for Depression Assessment Flyer (PDF)
- Clinical Screening for Depression (PDF)
- Controlling High Blood Pressure Flyer (PDF)
- Follow-up Care for Mental Illness Flyer (PDF)
- Improving Patient Engagement (PDF)
- Initiation and Engagement of Alcohol and Drug Treatment (IET) (PDF)
Partnership for Quality (P4Q) Program
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 (PDF).
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.