QUEST Integration - Philosophy of Care

Original Effective Date:

10/01/2003

Current Effective Date:

01/01/2015

At HMSA, we maintain the highest levels of quality health care for our members.

• We maintain a mutually respectful relationship with our members and health care practitioners to promote effective, quality health care and service.
• We value our members’ health and well-being. Prevention is a key component of our comprehensive care programs resulting in lower risks of illness and better management of problems.
• We hold the credentialed health care practitioners in our network to high standards of quality in the care and services that they provide and in the satisfaction of their patients.
• We inform our members about how their health plan works, how network practitioners are compensated, and how utilization management supports the delivery of quality health care.
• We encourage health care decision-making that’s based on appropriate care and service and existence of coverage.
• We reward appropriate decisions on care through financial incentives. We don’t reward practitioners or other individuals for denying payment or coverage and actively discourage barriers to care and service.
• We don’t encourage decisions that result in underutilization and we don’t provide financial incentives to utilization management decision-makers.
• We afford our members and practitioners the right to voice complaints, appeal decisions, and receive timely responses from us.

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