Common use of MANAGEMENT PROGRAM Clause in Contracts

MANAGEMENT PROGRAM. The Quality Management Program is designed to facilitate the receipt of quality care and services by Keystone members. The program is multidisciplinary, involving all departments within Keystone that have a direct impact on quality of care, services and accessibility. The program provides for the monitoring, evaluation, measurement, and reporting of the quality of medical care, the quality of service, and the safety of program services. Responsibilities of the Quality Management Program include but are not limited to:  Clinical appeals and Grievances;  Identification, evaluation and corrective action (as necessary) for all potential quality issues;  Analysis of member satisfaction surveys;  Monitoring of provider practice patterns; and  Compliance with all regulatory and accrediting standards. HEALTH EDUCATION AND WELLNESS PROGRAMS Keystone believes that providing health and wellness information assists individuals in adopting healthy lifestyles. From time to time, Keystone may provide on-line health education and wellness programs to its Members. Participation in these programs is optional to each Member. These programs are not insurance and are not an insurance benefit or promise under this Agreement. 24-Hour Nurse Line The Keystone 24-Hour Nurse Line staff of registered nurses are available to answer questions on health- related issues 24 hours a day, every day of the year. The service is designed to offer health and medical information, education and support. The service also offers assessment and advice, and suggests appropriate levels of care for symptomatic callers in the event members are unable to reach their physician. Members are encouraged to call 0-000-000-XXXX when they have the need for health information/education, or want assistance in determining how to best handle specific medical symptoms. Nurses are prepared to provide the following services:  Answers to a member’s questions on a health-related topic;  Send information/educational materials as appropriate to the member’s home; or  Refer a member to an Audio Library for comprehensive information on a specific topic, disease or procedure.  If the call is for symptomatic reasons, the nurses will:  Conduct an assessment of the member’s symptoms;  Direct the member to dial 911 in the event the symptoms described warrant it;  Suggest the appropriate level of care in the event the member’s physician is not available. Personal Profile Subscribers, age eighteen (18) and older, will be provided the opportunity to complete a Personal Profile. The Personal Profile is an online questionnaire that asks a series of health-related questions in order to generate personalized recommendations for health improvement. Upon completion of the Personal Profile, Keystone will provide a reward to the subscriber in an amount not to exceed $25.00. Online Health Coaching Subscribers, age eighteen (18) and older, will be provided the opportunity to complete an Online Health Coaching program. Online Health Coaching consists of a number of digital coaching programs that provides tools to help make lifestyle changes to address health and wellness concerns. Upon completion of one Online Health Coaching programs, Keystone will provide a reward to the subscriber in an amount not to exceed $25.00. HOW WE EVALUATE NEW TECHNOLOGY Changes in medical procedures, behavioral health procedures, drugs, and devices occur at a rapid rate. Keystone strives to remain knowledgeable about recent medical developments and best practice standards to facilitate processes that keep our medical policies up-to-date. A committee of local practicing physicians representing various specialties evaluates the use of new medical technologies and new applications of existing technologies. This committee is known as the Clinical Advisory Committee. The physicians on this Committee provide clinical input to Keystone concerning our medical policies, with an emphasis on community practice standards. The Committee, along with Keystone’s Medical Directors and Medical Policy Staff, look at issues such as the effectiveness and safety of the new technology in treating various conditions, as well as the associated risks. The Clinical Advisory Committee meets regularly to review information from a variety of sources, including technology evaluation bodies, current medical literature, national medical associations, specialists and professionals with expertise in the technology, and government agencies such as the Food and Drug Administration, the National Institutes of Health, and the Centers for Disease Control and Prevention. The five

MANAGEMENT PROGRAM. The Quality Management Program is designed to facilitate the receipt of quality care and services by Keystone members. The program is multidisciplinary, involving all departments within Keystone that have a direct impact on quality of care, services and accessibility. The program provides for the monitoring, evaluation, measurement, and reporting of the quality of medical care, the quality of service, and the safety of program services. Responsibilities of the Quality Management Program include but are not limited to:  Clinical appeals and Grievances;  Identification, evaluation and corrective action (as necessary) for all potential quality issues;  Analysis of member satisfaction surveys;  Monitoring of provider practice patterns; and  Compliance with all regulatory and accrediting standards. HEALTH EDUCATION AND WELLNESS PROGRAMS Keystone Xxxxxxxx believes that providing health and wellness information assists individuals in adopting healthy lifestyles. From time to time, Keystone may provide on-line health education and wellness programs to its Members. Participation in these programs is optional to each Member. These programs are not insurance and are not an insurance benefit or promise under this Agreement. 24-Hour Nurse Line The Keystone 24-Hour Nurse Line staff of registered nurses are available to answer questions on health- related issues 24 hours a day, every day of the year. The service is designed to offer health and medical information, education and support. The service also offers assessment and advice, and suggests appropriate levels of care for symptomatic callers in the event members are unable to reach their physician. Members are encouraged to call 0-000-000-XXXX when they have the need for health information/education, or want assistance in determining how to best handle specific medical symptoms. Nurses are prepared to provide the following services:  Answers to a member’s questions on a health-related topic;  Send information/educational materials as appropriate to the member’s home; or  Refer a member to an Audio Library for comprehensive information on a specific topic, disease or procedure.  If the call is for symptomatic reasons, the nurses will:  Conduct an assessment of the member’s symptoms;  Direct the member to dial 911 in the event the symptoms described warrant it;  Suggest the appropriate level of care in the event the member’s physician is not available. Personal Profile Subscribers, age eighteen (18) and older, will be provided the opportunity to complete a Personal Profile. The Personal Profile is an online questionnaire that asks a series of health-related questions in order to generate personalized recommendations for health improvement. Upon completion of the Personal Profile, Keystone will provide a reward to the subscriber in an amount not to exceed $25.00. Online Health Coaching Subscribers, age eighteen (18) and older, will be provided the opportunity to complete an Online Health Coaching program. Online Health Coaching consists of a number of digital coaching programs that provides tools to help make lifestyle changes to address health and wellness concerns. Upon completion of one Online Health Coaching programs, Keystone will provide a reward to the subscriber in an amount not to exceed $25.00. HOW WE EVALUATE NEW TECHNOLOGY Changes in medical procedures, behavioral health procedures, drugs, and devices occur at a rapid rate. Keystone strives to remain knowledgeable about recent medical developments and best practice standards to facilitate processes that keep our medical policies up-to-date. A committee of local practicing physicians representing various specialties evaluates the use of new medical technologies and new applications of existing technologies. This committee is known as the Clinical Advisory Committee. The physicians on this Committee provide clinical input to Keystone concerning our medical policies, with an emphasis on community practice standards. The Committee, along with Keystone’s Medical Directors and Medical Policy Staff, look at issues such as the effectiveness and safety of the new technology in treating various conditions, as well as the associated risks. The Clinical Advisory Committee meets regularly to review information from a variety of sources, including technology evaluation bodies, current medical literature, national medical associations, specialists and professionals with expertise in the technology, and government agencies such as the Food and Drug Administration, the National Institutes of Health, and the Centers for Disease Control and Prevention. The five