Skip Navigation to Quick LinksSkip Navigation to Content
Building Healthier Communities Together
Community Health Network of Connecticut
Members Providers About CHNCT Community Connections

QUALITY PROJECTS

HEDIS:  Health Employer Data Information Set. National benchmarking for clinical quality outcomes.

CAHPS:  Consumer Assessment of Healthcare Providers and Systems: Consumer Satisfaction of health plans including but not limited to access to care, timeliness of care, provider satisfaction.

Accreditation:  National accreditation by URAC (Utilization Review Accreditation Commission, part of NCQA (National Commission on Quality Assessment)

Audits:  Facilitation of audits by the State of CT Dept. of Social Services.

Quality Improvement

The Quality Improvement Department (QI) facilitates and monitors clinical services provided to members and develops initiatives to promote good health. This is accomplished through a collaborative aproach with QI and CHNCT as a whole. The Teams within QI are: Outreach; Quality; Credentialing & Disease Management.

Outreach:  This bilingual team (Spanish/English) is responsible for telephonic outreach to all members. The types of calls include but are not limited to: welcome calls, new baby calls, emergency room follow-up, prenatal & postpartum calls, EPSDT calls, mammogram/pap due & overdue calls, lead screening, PCP assignment, appointment scheduling & arranging transportation.

Quality:  A Registered Nurse investigates and researches all Quality of Care or Quality of Service complaints. This includes review of inpatient report to detect clinical issues and/or trends, discussion with CHNCT’s Medical Director regarding clinical matters and providers as appropriate. Additionally this RN conducts site visits as part of the Contracting process, is primary HEDIS nurse and serves as a liason with outside organizations.

Credentialing:  The Credentialing team is responsible for the initial credentialing and recredentialing of all practitioners as well as oversight audits of entites having delegated audit functions.

Disease Management:  The disease management programs are comprised of member education, support and intensive case management. Member incentives are utilized to help ensure member compliance and participation. Programs include: Healthy Beginnings; Dental; Healthy Airways; Healthy Cells and Healthy Kids.

Healthy Beginnings:  Member education and support of all pregnant members as well as intensive case management of all high risk pregnant members.

Dental:  Partnership with Benecare to identify members due for dental services and  focused outreach activities to call the member to remind and facilitate appointment scheduling as needed.

Healthy Airways:  Comprised of member education and support of members with a primary diagnosis of asthma. Intensive case management of high risk asthma members.

Healthy Cells:  Intensive case management of all members with sickle cell disease. The program is focused on facilitating wellness by reducing the number of sickle cell crises through compliance with care plans and medical follow up/appointments, supporting pain relief efforts, preventing infection, member education.

Healthy Kids:  Coordinated activities focused on facilitating well care visits for children and teens. Activities include monitoring all children for well care visits for the purpose of identifying those who are due or overdue for a visit.
Copyright 2009 © Community Health Network of Connecticut, Inc. All rights reserved.