South Atlantic Medical Group supports a comprehensive and integrated Quality Management Program. Its overarching goal is to objectively and systematically monitor and evaluate the quality, appropriateness, and outcome of care and services delivered to members.

Opportunities for improvement and best practices are continuously pursued. A formal evaluation of the Quality Management program is continuously performed and documented annually. The Program itself focused on member-centric care and patient-provider relationships while evaluating data-driven decision making throughout the organization.

There are specific activities linked to the QM program which include:

• Provider accessibility and availability,
• Provider and member satisfaction,
• Grievance resolution,
• Department call center management,
• Improvement in HCC scores resulting in higher RAF scores; and
• Population management (detailed below).

Population health, including HEDIS® and STARs measure improvement is the cornerstone of the Quality Management program. Using our HEDIS® engine, Cozeva, our quality specialists boost HEDIS® scores, STARs rating and population health initiatives with data quality solutions and initiatives that standardize and extract value from data submitted by network providers and health plans.