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AmeriHealth Quality Management Program

AmeriHealth’s Quality Management (QM) program provides a formal process to systematically monitor and objectively evaluate the company’s quality, efficiency, and effectiveness.

Program Activities

  • Provide tools and information to assist network providers in developing and maintaining a standard of care.
  • Manage partnership with network providers.
  • Monitor and evaluate care.
  • Suggest improvement to medical policies.
  • Oversee credentialing.
  • Oversee various processes for hearing grievances and appeals.
  • Collect member suggestions for quality initiatives.
  • Monitor aspects of care based on the demographics of members served (i.e., age, gender, and health status).
  • Investigate and track potential quality of care concerns through the recredentialing, grievance and appeal, and peer review processes.

Member Safety

We use plan-wide activities that increase member safety initiatives and reduce medical/medication errors. These activities include communicating information through mailings and newsletters.

Member Satisfaction

We investigate and resolve all quality of care and quality of service issues. Members may file a concern/complaint in writing or by calling Member Services at the number listed on back of the ID card.

Continuity and Coordination of Care

We assess continuity and coordination of care through three important aspects:

  1. coordination among medical providers treating the same patient;
  2. coordination between medical and behavioral care;
  3. monitoring for potential unavailability of access to care when a provider leaves a network and has patients in active treatment.

When a member is receiving an active course of treatment and his/her practitioner terminates from the health plan, the member may be eligible for continued access to the practice for a time period mandated by specific state regulations. The health plan will notify the member in writing of the termination and assist the member in arranging the continuation of care and selection of a new practitioner.

Quality Improvement

Members can request information about the Quality Improvement Program by calling the Member Services number on the back of the ID card.

Quality Management Program Information