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QI Program

The purpose of the Quality Improvement (QI) Program is to provide the infrastructure for the continuous monitoring, evaluation, and improvement in care, safety, and service.

Providers may obtain a copy of Lighthouse’s complete “Quality Improvement Program Description,” “Quality Improvement Program Evaluation,” or “Quality Program Committee Structure” and/or a copy of a summary of its annual evaluation by visiting the Lighthouse website when those materials are available or by contacting their Provider Relations Specialist.

Performance Improvement Process

The Physician Advisory Council “PAC” reviews and adopts an annual QI program and QI work plan based on Medicaid managed-care-appropriate industry standards. The QI adapts traditional quality/risk/utilization-management approaches to problem identification with the objective of identifying improvement opportunities. Most often, initiatives are selected based on data that indicates the need for improvement in a particular clinical or non-clinical area, and it includes targeted interventions that have the greatest potential for improving health outcomes or services. Performance-improvement projects, focused studies, and other quality-improvement initiatives are designed and implemented in accordance with principles of sound research design and appropriate statistical analysis. Results of these studies are used to evaluate the appropriateness and quality of care and services delivered against established standards and guidelines for the provision of that care or service. Each initiative is also designed to allow monitoring of improvement over time. The QI work plan serves as a continuous working guide for quality-improvement efforts. It integrates quality-improvement activities, reporting, and studies from all areas of the organization (clinical and service) to dictate timelines for completion and internal reporting, as well as requirements for external reporting. Studies and other performance measurement activities and issues to be tracked over time are scheduled in the QI work plan. Lighthouse communicates activities and outcomes of its quality-improvement program to both enrollees and providers through avenues such as the enrollee newsletter, provider newsletter, and the Lighthouse web portal. At any time, providers may request additional information on programs including a description of the QI program and a report on plan progress in meeting the QI program goals by contacting the Quality Improvement department.