An Operating Principle Based on Quality
Rocky Mountain Health Plans maintains our tradition and commitment of constantly looking for ways to improve the quality of care and level of service provided to our Members. We understand health care is personal and we take our responsibilities for providing access to care very seriously.
Provider Credentialing
All physicians and ancillary practitioners must successfully complete the Rocky Mountain Health Plans credentialing process before being accepted for participation. Rocky Mountain and its designees credential providers by using guidelines developed by the National Committee for Quality Assurance TM.
Quality Improvement Committee
This committee of physicians, chaired by our chief medical officer, meets quarterly to review quality improvement activities. The committee also acts in an oversight capacity recommending appropriate topics for Rocky Mountain-sponsored Continuing Medical Education programs for participating physicians. Rocky Mountain is accredited by the Colorado Medical Society to provide continuing medical education credits for physicians.
Peer Review
Multiple medical practice review committees, covering the entire state of Colorado, serve Rocky Mountain Health Plans and our Members by:
- assisting the Rocky Mountain Quality Improvement process by monitoring, recommending, and taking action to improve the quality of care and service for our Members.
- reviewing physician applications and credentialing data and making recommendations on admission to our provider network.
- reviewing and making recommendations regarding office record reviews, chronic illness care, health maintenance, safety, appropriateness of treatment, and medical record documentation.
HEDIS Reporting
Rocky Mountain collects and reports Health Employer Data Information Set (HEDIS) data. HEDIS is a nationally recognized, standardized quality measurement tool to inform Members, employer groups, and practitioners of Rocky Mountain's performance and how it compares to other health plans.
Satisfaction Surveys
Rocky Mountain performs several satisfaction surveys to see how our Members feel about the care and service they receive from us and from our providers. These surveys include the annual Consumer Assessment of Health Plans, primary care physician satisfaction surveys, and surveys on satisfaction with high volume specialists.
Additional information about our Quality Improvement program is available upon request. Please contact our customer service to request this information at 800-346-4643 or e-mail us at customer_service@rmhp.org
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Medicaid
The State of Colorado provides health care services to Medicaid clients through various contractual arrangements. Rocky Mountain Health Plans is one of the Colorado health plans in which Medicaid clients may enroll for access to medical services on the Western Slope. Enrollment in Colorado Medicaid occurs through county social services departments and Colorado Medicaid's enrollment contractor, HealthColorado.
As reported by the State of Colorado, HealthColorado program, the Rocky Mountain Health Plans Medicaid and Child Health Plan Plus Program (CHP+) continually receive the highest approval ratings in all program categories, including Overall Rating of Health Plan. This achievement signifies the commitment Rocky Mountain Health Plans has taken to provide quality health care services to the underserved in Colorado.
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Medicare
The Medicare Advantage Consumer Assessment of Health Plans Study (MA-CAHPS) is an annual survey conducted by the Center for Medicare and Medicaid Services (CMS), the federal agency that oversees the Medicare program. Although Rocky Mountain Health Plans is not a Medicare Advantage plan, this survey compares RMHP to Medicare Advantage plans throughout Colorado. Another important CMS evaluation is the Medicare Health Outcomes Survey. By assessing the experience and satisfaction of Medicare beneficiaries, these two surveys provide valuable insights into the CMS health care system. For additional information regarding these surveys, please contact Rocky Mountain Health Plans.
