Common use of Quality Management and Improvement Clause in Contracts

Quality Management and Improvement. Health Plan shall maintain an ongoing Quality Management and Improvement Program ("QI Program") to assess and improve the quality of clinical care and the quality of service provided to Members under the Managed Care Plans. The QI Program shall be maintained in accordance with the requirements of State and Federal Law and the standards of Accreditation Organizations. Medical Group and its Participating Providers shall participate, cooperate and comply with the QI Program. Medical Group shall, at the written request of Health Plan, make available its Participating Providers who are physicians to serve on Health Plan's QI Committee. Medical Group shall establish and maintain an independent quality improvement committee which shall meet as frequently as necessary, but at least monthly. A member of the Health Plan medical services staff may participate in Medical Group's quality improvement committee meetings. Medical Group shall keep minutes of its quality improvement committee meetings, a copy of which shall be made available to Health Plan upon ten (10) days written notice by Health Plan to Medical Group. If the functions of the quality improvement committee are performed by the Medical Group's utilization review committee, each committee must hold separately convened meetings and the minutes of each meeting must be separately maintained Medical Group shall develop written procedures for focused review or remedial action whenever it is determined by Health Plan's QI Committee that inappropriate or substandard Covered Services have been furnished or Covered Services that should have been furnished have not been furnished. Upon request, Health Plan shall assist Medical Group in the formulation of such focused review and remedial procedures.

Quality Management and Improvement. Health Plan shall maintain an ongoing Quality Management and Improvement Program ("QI Program") to assess and improve the quality of clinical care and the quality of service provided to Members under the Managed Care Plans. The QI Program shall be maintained in accordance with the requirements of State and Federal Law and the standards of Accreditation Organizations. Medical Group and its Participating Providers shall participate, cooperate and comply with the QI Program. Medical Group shall, at the written request of Health Plan, make available its Participating Providers who are physicians to serve on Health Plan's QI Committee. Medical Group shall establish and maintain an independent quality improvement committee which shall meet as frequently as necessary, but at least monthly. A member of the Health Plan medical services staff may participate in Medical Group's quality improvement committee meetings. Medical Group shall keep minutes of its quality improvement committee meetings, a copy of which shall be made available to Health Plan upon ten (10) days written notice by Health Plan to Medical Group. If the functions of the quality improvement committee are performed by the Medical Group's utilization review committee, each committee must hold separately convened meetings and the minutes of each meeting must be separately maintained maintained. Medical Group shall develop written procedures for focused review or remedial action whenever it is determined by Health Plan's QI Committee that inappropriate or substandard Covered Services have been furnished or Covered Services that should have been furnished have not been furnished. Upon request, Health Plan shall assist Medical Group in the formulation of such focused review and remedial procedures.