QI Program

Discover our quality improvement program

NovumHealth’s Quality Improvement (QI) Program reflects our commitment to facilitate ongoing improvement in the delivery of high-quality healthcare.

Highlights of our QI Program are presented in an annual report. Practitioners and members may request a copy of this publication by writing to:

Quality Department

NovumHealth
3321 N Buffalo Dr, Suite #200
Las Vegas, NV 89129

The purpose of the QI Program is to increase the quality of care for NovumHealth members by optimizing the delivery of cost-effective healthcare services. This goal is achieved by monitoring clinical care, clinical service, organizational service, and member experience.

QI Program Goal and Objectives

The goal of NovumHealth’s QI Program is to monitor the clinical care, clinical service, organizational service, and member experience provided to members while identifying opportunities for prioritizing, improving, and implementing quality improvement activities.

Below are objectives of the QI Program:

• Provide information and resources to members, providers, and other stakeholders who can improve the process of care.
• Implement effective managed care programs that aid in the transition of care throughout the continuum of services.
• Practice the principles of continuous quality improvement.
• Reduce variations in care and clinical practice patterns.

QI Program Activities

The primary activities of the QI Program focus on preventive care and disease management. These activities include:

• Data analysis and reporting, particularly for programs involving acute inpatient psychiatric admission and outpatient care (partial hospitalization programs, intensive outpatient programs, medication management, psychotherapy, and more).
• Member satisfaction surveys.
• Accessibility standards and timeliness.
• Network Adequacy and Practitioner Credentialing.
• Monitoring member complaints and appeals.
• Usage monitoring.

Evaluation of the QI Program

The QI Program is evaluated annually to assess the extent to which the scope, methodology, and activities succeed in meeting performance standards as they relate to NovumHealth’s purpose, goals, and objectives. Quality Improvement Activities (QIAs) are reviewed to determine their appropriateness, compliance with clinical standards, and impact on the quality of patient care and service rendered.

Evaluation of the QI Program should result in:

• Improved performance in the delivery of healthcare and services where the plan has identified problems and corrective actions have been implemented.
• Identifying the plan’s performance in quality improvement as it relates to improved outcomes and patient satisfaction using (Healthcare Effectiveness Data and Information Set) HEDIS measurements and in accordance with standards set by the National Committee for Quality Assurance (NCQA).
• Ensuring an appropriate level of effectiveness and efficiency in the plan’s performance.