Quality Assurance and Performance Improvement (QAPI) Program

AmeriHealth Caritas Next’s Quality Assurance and Performance Improvement (QAPI) program provides a framework for the evaluation of the delivery of health care, behavioral health care, and services provided to members. Practitioners and providers agree to allow AmeriHealth Caritas Next to use their performance data as needed for the organization's Quality Improvement (QI) activities to improve the quality of care and services, and the overall member experience.

Help us in our quality-related efforts. Speak with your Provider Network Account Executive or call Provider Services at 1-833-301-3377 to participate in one of our Quality committees.

About our QAPI program

The purpose of the QAPI program is to provide a formal process to systematically monitor and objectively evaluate the care and services our providers give to members, to ensure they are:

• Of high quality
• Appropriate
• Efficient
• Effective
• Safe

The QAPI program also provides oversight and guidance by:

• Determining practice guidelines and standards that measure the program's success.
• Complying with all applicable laws and regulatory requirements, including but not limited to applicable state and federal regulations and NCQA accreditation standards.
• Providing oversight of all delegated services.
• Ensuring that a qualified network of providers and practitioners is available to provide care and service to members through the credentialing/recredentialing process.
• Conducting member and practitioner satisfaction surveys to identify opportunities for improvement.
• Reducing health care disparities by measuring, analyzing, and re-designing services and programs to meet the health care needs of our diverse membership.

We develop goals and strategies considering:

• Applicable federal, state, and marketplace requirements and regulations
• Other regulatory requirements
• NCQA accreditation standards
• Best practice and evidence-based guidelines established by medical specialty boards and societies
• Public health goals
• National medical criteria

We also use performance measures such as the Quality Rating System (QRS) clinical measure data set, the Qualified Health Plan (QHP) Enrollee Survey, and provider surveys as part of the activities of the QAPI program.