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Quality Improvement Program

AmeriHealth Caritas Iowa's Quality Assurance and Performance Improvement (QAPI) program monitors and evaluates the quality of care and service provided to members. Practitioners and providers agree to allow AmeriHealth Caritas Iowa to use their performance data as needed for the organization's QI activities to improve the quality of care and services, and the overall member experience.

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/re-credentialing 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 state and federal laws and regulations and other regulatory requirements.
  • NCQA accreditation standards.
  • Evidence-based guidelines established by medical specialty boards and societies.
  • Public health goals.
  • National medical criteria.

We also use performance measures such as HEDIS®, CAHPS®, consumer and provider surveys, and available results of the External Quality Review Organization (EQRO), as part of the activities of the QAPI program.