Wellcare By ‘Ohana Health Plan Quality Improvement (QI) Program monitors and evaluates the quality, appropriateness, accessibility and availability of health care services.
Medical Records
QI may conduct annual medical record audits in physician offices. Patient records are reviewed for evidence that care and screenings have been documented. Complete information is available in the Medicare Advantage Provider manuals.
Clinical Practice Guidelines
Clinical Practice Guidelines (CPGs) outline medical standards of care and best practices.
HEDIS®*
HEDIS® is a mandatory process that occurs annually. We've developed this toolkit to help identify required preventive services.
