Quality Management

All Medicare Advantage organizations are required to have a quality improvement (QI) program as described in the federal regulations at 42 CFR §422.152, Quality improvement program. The requirements for the PDP Quality Assurance program are based in regulation as per 42 Code of the Federal Regulations § 423.153(c).  

The primary goal of the Medicare Advantage organization’s QI program is to affect sustained improvement in patient health outcomes. As provided under 42 CFR §422.152(c) and §422.152(d), Medicare Advantage’s QI program must include at least one chronic care improvement program (CCIP) for one chronic condition that measures and demonstrates improvement in health outcomes and beneficiary satisfaction.