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Programs

Quality Improvement Program

CHP Quality Improvement (QI) Program provides a formal process to objectively and systematically monitor and evaluate the quality, appropriateness, efficiency, safety, and effectiveness of care and service for CHP plan members. The program also sets forth a structured approach for conducting delegation oversight and monitoring compliance with State of Missouri and Federal Marketplace requirements. The program focuses on identifying and implementing opportunities for improving operational processes as well as health outcomes and satisfaction of members and practitioners/providers. 

Quality Improvement Program information and activities are shared regularly with CHP employees, members, and providers through blogs, website posting, flyers, and other forms of communication as needed. You can find detailed information within the full program document located here on our website, blog, and/or through your personal provider portal.

Medical Management Program

The CHP Medical Management Program is designed to partner with members to help them improve their health while utilizing appropriate medical services at the lowest cost. CHP and CoxHealth provide members with the knowledge and information needed to make informed care decisions that will maximize plan benefits and ultimately result in higher level of quality. The program allows the combining of medical claims, pharmacy claims, health records and enrollment data with the health system’s clinical resources, creating a comprehensive approach to identification, outreach and targeted care for our members. Unlike other standard medical management programs that only use claims data, our program integrates and coordinates all health system resources for our members. All CHP members are eligible for medical management. 

Medical Management Program information and activities are shared regularly with CHP employees, members, and providers through blog , website posting, flyers, and other forms of communication as needed. You can find detailed information within the full program document located here on our website, blog, and/or through your personal provider portal.

Risk Management Program

The purpose of CHP’s risk management program is to protect members, staff members and visitors from inadvertent injury. It is designed to provide guidance and structure for the organization’s clinical and business services that drive quality member care while fostering a safe environment. The focus of the risk management program is to provide an ongoing, comprehensive, and systematic approach to reducing risk exposures. Risk management activities include identifying, investigating, analyzing, and evaluating risks, followed by selecting and implementing the most appropriate methods for correcting, reducing, managing, and/or eliminating them.

Risk Management Program information and activities are shared regularly with CHP employees, members, and providers through blog , website posting, flyers, and other forms of communication as needed. You can find detailed information within the full program document located here on our website, blog, and/or through your personal provider portal.

Provider Satisfaction

Your satisfaction is so important to us at CHP! Each year we will have a Provider Satisfaction Survey to gauge our level of meeting provider needs and finding out where pain points exist. More information will be posted in Newsletters for details near the survey time. After the survey is complete, CHP will share the results internally with the health plan team and externally with our providers. You can find that information by logging in to your personal provider portal.

Member Satisfaction

CHP also takes member satisfaction and feedback into account for processes, operations, and services offered. There will be a yearly Member Satisfaction survey to determine satisfaction levels and pain points. Results from this annual survey can be found by logging in to your personal provider portal.

Behavioral Health

CHP wants to make behavioral health care easy and convenient for members to access. Through setting standards to care and using Integrated Behavioral Health in some CoxHealth clinics, we are knocking down barriers and opening avenues for our members to receive the care they need. Please see our standards for accessing behavioral health care below.

Behavioral Health Access Standards

  • Routine care within 10 business days
  • Urgent care within 48 hours
  • Non-life-threatening emergency care within 6 hours
  • Life-threatening emergency care 24 hours/7 days per week

CoxHealth Integrated Behavioral Health

Follow the link below to learn more about this program and how it could benefit your patients.

https://www.coxhealth.com/services/behavioral-health/integrated-behavioral-health/

Advance Directives

CHP encourages every member to complete an Advance Medical Directive, and for our providers to facilitate their completion. You can find more information, including forms and directions, on the CoxHealth website at the link below.

https://www.coxhealth.com/patients-and-visitors/patient-rights-and-responsibilities/advance-medical-directives/

Preventive Health Guidelines:

U.S. Preventive Services Task Force A and B Recommendations under the Affordable Care Act
https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/ 

You can also view preventive service information for adults, women and children on HealthCare.gov at:

Clinical Practice Guidelines:

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Contact Us

Phone: 417.269.4679
or 800.664.1244
Fax: 417.269.2949

Mailing Address
Cox HealthPlans
PO Box 5750
Springfield, MO 65801-5750

Or visit us at
Cox HealthPlans
Medical Mile Plaza
3200 S. National, Building B
Springfield, MO 65807

 

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