Kern Health Systems (KHS) recognizes that a strong Quality Improvement (QI) Program must be the foundation for a successful Managed Care Organization (MCO). In the basic program design and structure, KHS QI systems and processes have been developed and implemented to improve, monitor and evaluate the quality and safety of care and service provided by contract providers and organizations for all aspects of healthcare delivery consistent with standards, laws and regulations.
Quality Improvement Program
The KHS Quality Improvement Program Description is a written description of the overall scope and responsibilities of the QI Program. The term healthcare is used throughout the Program Description to refer to the medical, optical and behavioral healthcare of the member. The QI Program actively monitors, evaluates and takes effective action to address any needed improvements in the quality, appropriateness, safety and outcomes of healthcare services delivered by all providers rendering services to members through the development and maintenance of an interactive healthcare system.
The KHS QI Program applies to all programs, services, facilities and individuals that have direct or indirect influence over the delivery of healthcare to members. This may range from choice of provider to the provision and institutionalization of the commitment to environments that improve clinical quality of care (including behavioral health), promote safe clinical practices and enhance service to members throughout the organization.
- 2020 QI program.
- 2020 QI workplan.
- 2021 MCAS/HEDIS Provider Resources Manual.
- 2021 MCAS/HEDIS Measures Codes.
Facility site and medical review surveys
All primary care provider sites participating in the Medi-Cal Managed Care Program as part of the initial credentialing process are required by California statute Title 22, 56230 to complete an initial site inspection and subsequent periodic site inspections regardless of the status of other accreditation and/or certifications, if there is no evidence of a current passing survey completed by another local plan, or when a contracted provider from an approved site moves to a new site that has not previously been reviewed.