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Quality Improvement Toolkit

The Quality Improvement (QI) Toolkit consists of seven training topics that are required for HPSM providers.

Healthcare Effectiveness Data and Information Set

Provide access to all medical records in a timely manner on an annual basis for the Healthcare Effectiveness Data and Information Set (HEDIS) reporting requirements.

Initial Health Assessment (IHA)

Conduct an IHA with all newly enrolled HPSM members within 120 days.

Language Assistance (Cultural and Linguistic Services)

Develop and implement a plan to deliver culturally and linguistically appropriate services (CLAS) to all eligible members with limited English proficiency (LEP) or sensory impairment.

Medical Record (MRR) and Facility Site Reviews (FSR)

FSR and MRR are the application of standards by the California Department of Health Care Services (DHCS). All PCP sites must undergo an initial site review upon contracting with HPSM and subsequent reviews thereafter. The reviews consist of a facility site review and a medical record reviews which are conducted to determine if:

  • Primary health care services provided are appropriate and complete
  • Provider is compliant with current safety standards
  • Provider is compliant with local, state, and federal laws and regulations
  • Provider has processes in place to ensure preventive, continuity and coordination of care are fully addressed

A detailed explanation of the standards can be found in the policy letter. Certified nurse reviewers conduct the review using the standardized DHCS audit tools below:

Nurse Advice Line

Understand how HPSM’s Nurse Advice Line Service supports existing phone triage systems at your clinic or office. Providers must offer members access to a phone triage service 24 hours a day, 7 days per week.

Potential Quality Issue (PQI)

Understand HPSM’s method for the identification, reporting and processing of a Potential Quality Issue to determine opportunities for improvement in the provision of care and services to our members. Direct the appropriate actions for improvement based upon outcome, risk, frequency and severity.

Seniors and Persons with Disabilities (SPD)

Identify and address barriers to access and care (physical access, communication, etc.) for seniors and/or persons with disabilities (SPD).

Tobacco Prevention and Cessation Services

Identify (initially and annually) all members (of any age) who use tobacco products and note this on the Staying Healthy Assessment (SHA).