Quality Management

The Quality Management (QM) Program of Quest Behavioral Health has as its primary goal the continuous improvement of clinical care and service to members through the collaborative relationship it has with providers. The QM Program focuses on establishing positive associations with members and providers to achieve superior clinical and customer service outcomes while effectively managing cost. The QM Program evaluates and intervenes with quality management initiatives to improve patient care and service delivery. All aspects of mental health and chemical dependency services are subject to quality oversight. Administrative services and clinical care provided by all contracted practitioners, facilities, allied health professionals and Quest personnel are included in quality oversight.

The QM Program coordinates its efforts with all other departments in Quest Behavioral Health. The Member Advisory Panel, Provider Advisory Panel, and Medical Directors Advisory Group provide input to the QM Program. In addition, a Quality Management and Improvement Committee made up of providers, health plan representatives, medical delivery systems representatives and Quest staff members meet on a monthly basis to analyze and recommend quality improvement activities.

The scope of the QM program is comprehensive and encompasses all aspects of the organization. The QM Program works directly with member services, utilization management, provider relations, and the claims department to improve services for members and providers. Quality concerns reported to the QM Department are thoroughly investigated. When opportunities are identified, we take actions to improve services. Data is collected and analyzed from various departments and compared to regional, as well as, national information. From that information Quest develops goals and implements strategies to achieve those goals.

The QM Program focuses on indicators and performance measures in areas such as patient safety, availability of providers, accessibility of providers, member and provider satisfaction activities, continuity and coordination of care, identification of best methods of treatment through the use of clinical practice guidelines, utilization management, preventive care and other areas.

The Quality Management Department welcomes recommendations or comments from both providers and members. If you would like a more detailed summary of the QM Program please contact the Quality Management Department by calling 800.364.6352 or email us at qm@questbh.com.