Quality Assessment and Performance Improvement (QAPI)
As our valued provider, your ability to serve our members is important. Nebraska Total Care is here with information to help you provide the very best care. This information is part of our Quality Improvement (QI) program designed to address both the quality and safety of services provided to your patients and our members.
We are committed to the provision of a well-designed and well-implemented Quality Improvement (QI) program. Our culture, systems and processes are structured around this mission to improve the health of all enrolled members.
Scope
The scope of the QI Program is comprehensive and addresses both the quality and safety of clinical care and quality of services provided to Nebraska Total Care's members including medical, behavioral health, dental care and vision care. We incorporate all demographic groups, care settings, and services in QI activities, including preventive care, emergency care, primary care, specialty care, acute care, short-term care, and ancillary services.
Goals & Objectives
Our primary quality improvement goal is to improve members’ health status through a variety of meaningful quality improvement activities implemented across all care settings and aimed at improving quality of care and services delivered. Nebraska Total Care utilizes the Healthcare Effectiveness Data and Information Set (HEDIS) and Centers for Medicare and Medicaid (CMS) Adult and Child Core Sets that both include a wide variety of standardized measures to evaluate quality performance across the nation.
Additionally, the health plan and its provider network utilize the Consumer Assessment of Healthcare Providers and Systems, or CAHPS®. Annually, results of Nebraska Total Care’s member satisfaction survey can be found in the Nebraska Total Care’s Health Plan Quality Improvement Evaluation posted to this website.
As a healthcare provider, you should know about CAHPS® and what the CAHPS® survey is asking your patients about Physician Communication. See the CAHPS® Overview to learn what physicians can do to improve communication with our members.
- CAHPS® Overview for Physicians
- CAHPS® Provider Reminders for Member Satisfaction
Credentialing Standards
For consideration to participate in the Nebraska Total Care network, all licensed physicians and other licensed healthcare professionals who have an independent relationship with Nebraska Total Care must complete an application for participation and submit copies of applicable supporting documentation.
Cultural Competency Plan
Nebraska Total Care is committed to establishing multicultural principles and practices throughout its organizational systems of services and programs. That mission is supported by facilitating the process by which Nebraska Total Care can respond to the health care needs of all individuals, regardless of their ethnicity, cultural, religious beliefs or language. Our Cultural Competency plan is reviewed and updated annually.
Participation in QI
Nebraska Total Care requires providers and practitioners to cooperate with all Quality Improvement activities, as well as allow the use of provider and/or practitioner performance data, to ensure the success of the QI Program. If you are interested in learning more about Nebraska Total Care's QI Program, please contact Nebraska Total Care at 1-844-385-2192 (TTY 711) and ask to speak with the Quality Improvement Department.