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Improving Quality at RMHP

Improving Quality at RMHP

The objective of the RMHP Quality Improvement Program is to monitor, measure, and take effective actions on identified opportunities to improve the quality and safety of health care and services through the cycle of objective evaluation, intervention, and reevaluation. These activities are the summation of efforts by several departments including Quality Improvement, Care Management, Pharmacy, Provider Network Management, Customer Service, Health Promotions, Claims, Home Health, Member Administration, Marketing, Information Technologies, and effective professional peer review. Pertinent activities from all of these processes are reported and integrated into the QI Program.


The goals of the RMHP QI Program are to:

  • Improve the quality of all categories of health care, including behavioral health care and chronic illness care, provided to the entire population of RMHP Members.
  • Promote clinical care and services that are delivered in a safe, timely, efficient, effective, equitable, and patient-centered manner.
  • Respond to the needs and expectations of RMHP internal and external customers by evaluating clinical and service performance relative to meeting those needs and expectations.
  • Encourage and engage in effective professional peer review.
  • Support and facilitate health care entities in geographically distinct areas in coordinating the collection and utilization of quality improvement information.
  • Evaluate and improve the effectiveness of the QI Program by developing action plans based on measured outcomes.
  • Report results of quality improvement efforts.
  • Ensure compliance with statutory requirements and accreditation standards.


Additional information about our Quality Improvement Program is available upon request. Please contact our customer service to request this information at 800-346-4643 or e-mail us.

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HEDIS INFORMATION

HEDIS Information Sheet

RMHP 2018 HEDIS Measures

These Clinical Practice Guidelines (“Guidelines”) are not meant to replace the clinical judgment of a Member’s physician or other professional health care provider (collectively, “Providers”). As such, these Guidelines do not establish a standard of care or practice, or replace appropriate clinical decision-making. These Guidelines must always be used in the context of a health care Provider's clinical judgment in the care of a particular patient. For that reason, Guidelines may be viewed as an educational tool to provide information and assist Members and Providers in choosing appropriate health care for specific clinical conditions and diagnoses. Deviations from the Guidelines may be necessary and appropriate in certain individual circumstances. These Guidelines were developed by RMHP based on evidence-based clinical guidelines from nationally recognized sources and best practices that were available at the time of publication. More recent information, evidence and practice standards may be available; therefore, persons reviewing these Guidelines should always use independent judgment in their interpretation. Publication of these Guidelines is not a promise or guarantee of coverage. Individuals should review their coverage documents or contact RMHP Customer Service @ 800-346-4643 or customer_service@rmhp.org to determine what health care services are covered benefits and if other conditions or limits of coverage apply.

Clinical Practice Guidelines