Purpose of Quality Improvement (QI) Program

The Horizon Quality Improvement Program is a coordinated and comprehensive program designed to monitor, assess and improve the quality and appropriateness of care and services provided to members/covered persons with coverage within the respective lines of business. This is accomplished by creating an infrastructure and set of business processes to make the achievement of high quality outcomes and service an integral part of the way Horizon does business. This document serves as a summary description of the Horizon Quality Improvement Program. It does not include the quality activities of Government Programs; however, is cross-shared to ensure collaboration and consistency. Additionally, more detailed descriptions of program components are described in other policies, procedures, and workflows. The Horizon Quality Improvement Program is revised as needed and reviewed at least annually. It is available for review by the various regulatory and accreditation entities (e.g. – Department of Banking and Insurance and Centers for Medicare and Medicaid Services and National Committee for Quality Assurance (NCQA) upon request. It is also made available to our members and network providers.