Quality Improvement The Quality Improvement Department is built on the well-known and well-regarded structure-process-outcome model of quality. This model employs the proactive Plan-Do-Check-Act (PDCA) cycle of continuous quality improvement which includes the following activities:
- Identification of processes which require improvement
- Organization of workgroups which understand the process which requires improvement.
- Understanding sources of variation and error within the process
- Development of the optimal intervention to improve the process
- Implementation of the intervention
- Collection of data to evaluate the results of process improvement
- Continuing the quality improvement process as needed
In addition to its proactive quality improvement activities, continuous program monitoring and evaluation plays a critical role within the organization. As such, the plan participates in an annual HEDIS audit to ensure the highest standards of care and service are met. The plan also reviews the results of its Consumer Assessment of Health Plan Survey (CAHPS) data to ensure the highest degree of member satisfaction. When quality of care issues, quality of service issues, or member satisfaction issues are identified, they are subject to the scrutiny of the PDCA quality improvement cycle outlined above. The result of these ongoing and proactive activities is improved quality of care, better health outcomes for our members, and greater levels of member satisfaction. Questions pertaining to plan quality assurance processes should be addressed to Pat Hayes (713) 558-4644.
Lastly, the plan has quality improvement policies and procedures in place for drug utilization review, medication therapy management, and pharmacy-related appeals and grievances. Questions relating to the Medicare Part D Drug program should be directed to Member Services.
Hours of Operation: (November 15, 2007 to December 31, 2007)
8 AM – 11 PM EST, 7 days a week
All requests for exceptions, appeals & grievance data can also be directed to the Member Services number listed above.
Exceptions, Appeals, & Grievances Forms
Please download and print the Appeals & Grievance form based on the state where you live.
American Progressive members include individuals who live in these states: ME, NH, and NY
Member Services: 1-800-551-6014
TTY: 1-800-958-2692
Pyramid Life members include individuals who live in these states: CO, GA, IL, IA, MI, MN, NC, AND VA, AL, AZ, AR
Member Services: 1-800-551-6233
TTY: 1-800-958-2692
Marquette National Life members include individuals who live in these states: AL, AZ, AR, CA, DE, DC, FL, HE, IN, KS, KY, LA, MD, MS, MO, MT, NE NV ND OH, OK, OR, PA, SC, SD, TN, TX, WA, WV, WI, WY.
Member Serivces: 1-866-222-5137
TTY: 1-800-958-2692
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