PLAN QUALITY IMPROVEMENT Clause Samples

PLAN QUALITY IMPROVEMENT. Following Paragraph 2.7 of the Agreement, the following provisions shall also apply. “Blue Shield retains responsibility for Quality Improvement and Quality Management Programs. Quality Improvement and Quality Management Programs are not delegated to Group. Group however agrees to comply with Blue Shield’s Quality Improvement Program for both hospital and office based care. Blue Shield’s Quality Improvement Program shall be developed in consultation with Blue Shield Providers to ensure that practice guidelines of quality improvement and quality management pursuant to Medicare regulations and CMS instructions are met. Group agrees to maintain a Quality Management Program which states that Group will review on a prospective, concurrent and retrospective basis the quality, appropriateness, level of care and utilization of Group Providers. The Quality Management Program will include among others an annual evaluation, annual quality management goals, proposed quality management studies, a description of the quality management committee and frequency of meetings. Group shall notify Blue Shield of any changes to the Quality Management Plan which shall be subject to prior approval by Blue Shield.”