QI & UM Programs

Asset 2

QI & UM Programs

Quality Improvement and Utilization Management Programs

CHCN’s Quality Improvement program conducts audits of access, patient satisfaction, diabetes, asthma, hypertension and mammography rates to support ongoing implementation of optimal clinical care. We continue to sustain and spread prevention and chronic disease collaboratives in the areas of diabetes, asthma, and cardiovascular health. We provide technical assistance to our health centers to assure they are in full compliance with applicable clinic regulations. Additionally, we partner with agencies in the community to promote disease prevention and treatment.

Upon request, CHCN makes information about its Quality Improvement (QI) program available to its members and practitioners.

Information provided about the QI program may include:

  • Description of the program
  • Program goals
  • Report on progress in meeting program goals
  • Achievements related to member care and service
  • Annual plans
  • Annual reports
  • Members, practitioners and the public may also request information about CHCN’s Utilization Management (UM) program.

Information provided about the UM program may include:

  • Description of the program
  • Criteria and/or guidelines used for authorization, modification or denial of services
  • UM policies and procedures (please specify when requesting

Information can be mailed out within two weeks of request. Ten cents per page is charged for copying and postage. Fees will be waived for Medi Cal members.

All CHCN providers and employees who make UM decisions sign a statement affirming that:

  • UM decision making is based only on appropriateness of care and service and existence of coverage
  • The organization does not specifically reward practitioners or other individuals for issuing denial of coverage or service care
  • Financial incentives for UM decision makers do not encourage decisions that result in underutilization

To request information, contact: Laura Miller, MD, Chief Medical Officer by email at: lmiller@chcnetwork.org.