An Operating Principle Based on Quality

RMHP is proud to be part of an exceptional health care delivery system in Colorado. We focus on our relationship with physicians, hospitals, and other providers to ensure Members get the care they need while improving quality of care and patient health.  We understand health care is personal and we take our responsibilities for providing access to care very seriously.

Provider Credentialing

All physicians and ancillary practitioners must successfully complete the RMHP credentialing process before being accepted for participation. RMHP and its designees credential providers by using guidelines developed by the National Committee for Quality AssuranceTM (NCQA).

Quality Improvement Committee

This committee of physicians, chaired by our chief medical officer, meets quarterly to review quality improvement activities. The committee also acts in an oversight capacity recommending appropriate topics for RMHP-sponsored Continuing Medical Education programs for participating physicians. RMHP is accredited by the Colorado Medical Society to provide continuing medical education credits for physicians.

Peer Review

Multiple medical practice review committees, covering the entire state of Colorado, serve RMHP and our Members by:

  • Supporting the RMHP Quality Improvement process by monitoring, recommending, and taking action to improve the quality of care and service for our Members.
  • Reviewing physician applications, credentialing data, and making recommendations on admission to our provider network.
  • Reviewing and making recommendations regarding office record reviews, chronic illness care, health maintenance, safety, appropriateness of treatment, and medical record documentation.

HEDIS Reporting

RMHP collects and reports Health Employer Data Information Set (HEDIS) data. HEDIS is a nationally recognized, standardized quality measurement tool to inform Members, employer groups, and practitioners of RMHP’s performance and how it compares to other health plans.

Satisfaction Survey

RMHP performs several satisfaction surveys to see how our Members feel about the care and service they receive from us and from our providers. These surveys include the annual Consumer Assessment of Health Plans, primary care physician satisfaction surveys, and surveys on satisfaction with high volume specialists.

Additional information about our Quality Improvement program is available upon request. Please contact Customer Service to request this information at 800-346-4643 or email us at customer_service@rmhp.org

Medicaid

The State of Colorado provides health care services to Medicaid clients through various contractual arrangements. RMHP is one of the Colorado health plans in which Medicaid clients may enroll for access to medical services on the Western Slope. Enrollment in Colorado Medicaid occurs through county social services departments and Colorado Medicaid's enrollment contractor, HealthColorado.

As reported by the State of Colorado, HealthColorado program, RMHP’s Medicaid and Child Health Plan Plus (CHP+) programs continually receive the highest approval ratings in all program categories, including Overall Rating of Health Plan. This achievement signifies the commitment RMHP has taken to provide quality health care services to the underserved in Colorado.

Medicare

The Medicare Advantage Consumer Assessment of Health Plans Study (MA-CAHPS) is an annual survey conducted by the Center for Medicare and Medicaid Services (CMS), the federal agency that oversees the Medicare program. Although RMHP is not a Medicare Advantage plan, this survey compares RMHP to Medicare Advantage plans throughout Colorado. Another important CMS evaluation is the Medicare Health Outcomes Survey. By assessing the experience and satisfaction of Medicare beneficiaries, these two surveys provide valuable insights into the CMS health care system. For additional information regarding these surveys, please contact RMHP.