Measure Analyze, Improve

FHC’s Quality Management Program was designed to promote and ensure quality in the delivery of care and services in order to help the members achieved a better life. Our program emphasizes that healthcare must be provided according to the six aims of healthcare quality: safety, effectiveness, patient-centered, timely, efficient and equitable. Furthermore, the program adopted a philosophy of continuous improvement of our processes. The Quality Management Program encourages objective and systematic measurement, monitoring and evaluation of our services and the implementation of improvement activities to address barriers identified. To achieve this purpose, FHC supports the following aspects of quality improvement:

  • Measurement and analysis of performance measures
  • Delivery of healthcare based on evidence-based Clinical Practice Guidelines
  • Implementation of Quality Improvement Projects

Some of the activities that the Quality Management Program carries out are:

  • Evaluation of quality in healthcare through the monitoring of HEDIS® (Healthcare Effectiveness Data and Information Set) data and other quality indicators.
  • Experience surveys to members, practitioners and providers.
  • Audits to the providers’ network.
  • Development of quality activities based on the population needs, ensuring that care is ethnic and culturally relevant.
  • Education on quality topics to our providers and employees.

Program Scope

The Quality Management Program’s scope includes all services provided by the organization. Its purpose is ensuring the necessary structure and processes to meet members and clients’ needs.  The scope of the Quality Management Program includes, but is not limited to:

  • Safety, effectiveness and efficiency of the provision of services to our members, including those with special needs.
  • Accessibility and adequacy of the Providers Network
  • Ensure that there are no racial, ethnic or cultural disparities that may affect the quality of our services
  • Member experience, complaints and appeals
  • Program effectiveness assessment
  • Internal processes related to the quality of non-clinical services such as credentialing, customer service, claims payment and education.

We look forward to help you

FHC’s providers can direct their questions about quality activities and/or feedback to the Quality Department using the link below. We will be glad to clarify questions and discuss the goals of HEDIS® measures, quality initiatives and how we could collaborate to improve our processes.

Providers can also contact the Quality Department through the phone at 787-622-9797 ext. 2010 or 2096.

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