QI Program

The purpose of the QAPI Program is to plan, implement and monitor ongoing efforts that demonstrate improvements in member safety, overall health and care experience.

Since 2015, Superior HealthPlan has been one of the top-rated Medicaid plans in Texas, earning a rating of 3.5 or higher on a 5.0 scale on the National Committee for Quality Assurance (NCQA) Medicaid Health Insurance Plan Ratings. This includes a rating of 3.5 for 2022. 

NCQA evaluates how well a health plan manages all parts of its delivery system – physicians, hospitals, other providers and administrative services – in order to continuously improve the quality of care and services provided to its members. The NCQA seal is a widely recognized symbol of quality. NCQA health plan accreditation surveys include rigorous, on-site and off-site evaluations of 70 standards and selected HEDIS measures. A national oversight committee of physicians analyzes the survey findings and assigns an accreditation level based on the performance level of each plan being evaluated to NCQA’s standards. This recognition is the result of Superior’s long-standing dedication to provide quality health care service and programs to our members.

Superior has maintained NCQA’s Long-Term Services and Supports (LTSS) Distinction since 2018. This distinction demonstrates that Superior meets all key NCQA LTSS standards, in areas such as conducting comprehensive assessments, managing care transitions, performing person-centered assessments and planning and managing critical incidents.

Superior also earned the NCQA Distinction in Multicultural Health Care for exceling in providing culturally and linguistically sensitive services while working to reduce health care disparities. Superior will be transitioning to NCQA Health Equity Accreditation in 2024.

The following are Superior’s goals and objectives for its QAPI Program:

• Safety - Care doesn’t harm members.
• Member Experience - Members feel valued.
• Efficiency - Resources are used to maximize quality and minimize waste.
• Eliminating Disparities - Quality care is reliably received regardless of geography, income, language or diagnosis.

In support of the QAPI Program, the QI Department monitors the quality of health care services provided to Superior members, addressing two basic areas:

• Quality of service
• Quality of care

To monitor the quality of services you provide to Superior’s members, the QI Department reviews the availability of appointments for emergencies, urgent care and preventive care. Superior also monitors availability for after-hours calls from members, as well as how satisfied members are with services provided by you and your office staff.

To monitor quality of service, Superior’s QI Department may assess:

• Satisfaction levels from Superior providers and members utilizing both satisfaction surveys and complaints.
• Turn-around time in responding to provider issues.
• Appropriate claims payment and adjustment timeframes.
• Customer service performance with incoming provider calls.
• To monitor quality of care, Superior’s review processes may include:
• Review and distribution of practice guidelines for diseases and conditions most likely to impact Superior’s members, as well as pediatric and adult preventive health care guidelines, including compliance with practice guidelines.
• Targeted audits of primary care practices to promote the confidentiality of medical information and compliance with standards for appropriate medical record documentation, when necessary.
• Monitoring and support of communication systems that promote continuity and coordination of care.
• Investigation of potential quality of care complaints, including the tracking and trending of complaints.

Superior places great emphasis on the wellness of its members. A large part of quality health care delivery is treating the whole patient and not just the medical condition. Superior encourages providers to provide culturally competent care that aligns with the National Standards on Culturally and Linguistically Appropriate Services (CLAS). Superior maintains policies which emphasize the importance of culturally and linguistically competent care to Superior’s membership of all cultures, races, languages, ethnic backgrounds and religions in a manner that recognizes values, affirms and respects the worth of the individual enrollees while protecting and preserving the dignity of each member. Sensitivity to differing cultural influences, beliefs and backgrounds, can improve a provider’s relationship with patients and, in the long run, the health and wellness of the patients themselves.

For additional resources, please visit Superior's Health Equity Program webpage.

Superior requires that providers and practitioners cooperate with all QI activities, as well as allow the use of provider and/or practitioner performance data, to ensure the success of the QAPI Program. If you are interested in learning more about the QAPI Program, please contact your Superior HealthPlan Accounnt Manager for guidance on how you can participate, or how to learn more about the QI Department.

• After-Hours Telephone Accessibility (PDF)
• Appointment Availability Standards (PDF)
• CAHPS Provider Tip Sheet (PDF)
• Diabetes Management Resources (PDF)
• Disease Management Program Guide (PDF)
• HEDIS Quick Reference Guide (PDF)
• HEDIS MY 2022 Technical Specifications (PDF)
  
• Important Provider Resources: Website and Secure Provider Portal (PDF)
• Let’s Get Active Handout (PDF)
• Medicare Health Outcomes Survey (PDF)
• My Wellness and Prevention Checklist (PDF)
• Prenatal and Postpartum Care Quality of Care Performance Measure (PDF)
• Quality Assessment and Performance Improvement Program Committees (PDF)
• Risk Adjustment Documentation and Coding Tips (PDF)
• Transitional Care Management Services Fact Sheet (PDF)

Access immunization and Human Papillomavirus (HPV) resources on Superior's Immunization Toolkit.