Skip to main content

If you have any questions regarding the information in CCA’s provider manual, please email Provider Relations at [email protected].

Section 13: Quality Improvement Program

Quality Improvement Program

Commonwealth Care Alliance is committed to providing the highest quality, most effective health care to its members. In pursuance, Commonwealth Care Alliance’s framework for quality improvement is designed to integrate quality assessment and performance improvement activities throughout all levels of its care delivery system. As a ‘consumer experience’ governed organization, Commonwealth Care Alliance’s Quality Program is structured to ensure that the member’s perspective is built in to all elements of its quality improvement activities. An underlying tenet of the program is that a true partnership between those receiving care and those providing and managing care can promote autonomy, independence, and better health outcomes.

The Quality Program is designed to:

  • Understand the needs, expectations, and satisfaction of members and caregivers and implement improvements to incorporate these perspectives into care delivery and system operations
  • Continually improve organizational and clinical processes throughout the delivery system based upon analysis of available data and clinical, administrative, and member input from across the network
  • Improve clinical quality by identifying and disseminating best clinical practices throughout the network

Quality Program Objectives

  • To ensure the effective, timely and safe delivery of care and care coordination to members at the optimal level of quality
  • To assess and evaluate the quality and appropriateness of care across the provider network
  • To design effective mechanisms for problem identification, assessment and resolution at the individual, practice site, and system-wide levels
  • To assess, evaluate and monitor key areas of clinical care and care coordination and identify opportunities for improvement when indicated
  • To promote mechanisms for the integration of risk management, utilization review and other activities in a comprehensive Quality Improvement Program
  • To identify deviations from standards and address such deviations in a manner that optimizes health outcomes
  • To ensure that professional competency and practices are routinely and reliably monitored and evaluated
  • To ensure program compliance with state, federal, contractual and other regulatory requirements