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Medicaid Open Enrollment begins October 1st. To join Delaware First Health, call the Health Benefits Manager at 1-800-996-9969
Medicaid Open Enrollment begins October 1st. To join Delaware First Health, call the Health Benefits Manager at 1-800-996-9969

QI Program

We are committed to the provision of a well-designed and well-implemented Quality Improvement (QI) program. Our culture, systems and processes are structured around this mission to improve the health of all members.

Scope

The scope of the QI Program is comprehensive and addresses both the quality and safety of clinical care and quality of services provided to Delaware First Health's members including medical, behavioral health, dental and vision care. We incorporate all demographic groups, care settings, and services in QI activities, including preventive care, emergency care, primary care, specialty care, acute care, short-term care, long-term care (depending upon Delaware First Health's products), and ancillary services.

Goals & Objectives

Our primary quality improvement goal is to improve members’ health status through a variety of meaningful quality improvement activities implemented across all care settings and aimed at improving quality of care and services delivered.

Credentialing Standards

For consideration to participate in the Delaware First Health network, all licensed physicians and other licensed healthcare professionals who have an independent relationship with Delaware First Health must complete an application for participation and submit copies of applicable supporting documentation.

Cultural Competency and Sensitivity Plan

As a company dedicated to managing the healthcare of our beneficiaries, Delaware First Health is committed to establishing multicultural principles and practices throughout its organizational systems of services and programs. That mission is supported by facilitating the process by which Delaware First Health can respond to the health care needs of all individuals, including those with limited English proficiency (LEP) and diverse cultural and ethnic backgrounds, abilities, and regardless of gender identity, sexual orientation or religion. Delaware First Health maintains an adequate network of primary care and specialty practitioners, and regularly monitors how effectively the network meets the needs and preferences of our membership.

  • The Cultural Competency Plan is reviewed and updated annually, and ensures that we address the cultural needs of our members by:
  • Identifying and utilizing the appropriate resources for interpreter services: Delaware First Health provides professional, independent interpreter and translation services to members within the service area. Through effective partnerships with interpreters, Delaware First Health completes requests for onsite sign language and LEP/oral interpreters.
  • Evaluating provider access and availability: We have contracted with providers that speak the languages required by our member population, with the most common language continuing to be Spanish.
  • Identifying organizations and advocates that could work with LEP communities and individuals in a culturally competent way;
  • Recruiting and training culturally diverse staff, including Care Managers and Participating Providers that will be able to operate fluently and deliver culturally and linguistically appropriate care with all communities throughout the State, including Tribal communities. This is done through Cultural Sensitivity training for all Delaware First Health staff through our robust Cultural Sensitivity training.
  • Developing a set of cultural competency standards designed to help all parts of the care management process deliver culturally sensitive care;
  • Identifying and developing intervention strategies for high-risk health conditions found in certain cultural groups; including American Indian/Alaska Native cultural competency

 

Participation in QI

Delaware First Health requires providers and practitioners to cooperate with all Quality Improvement activities, as well as allow the use of provider and/or practitioner performance data, to ensure the success of the QI Program. The Delaware First Health QI Program is outlined on the website and is available upon request. If you are interested in learning more about Delaware First Health's QI Program, please contact Delaware First Health at 1-877-236-1341 (TTY: 711) and ask to speak with the Quality Improvement Department.

Consumer Assessment of Healthcare Providers and Systems (CAHPS®)

Delaware First Health is dedicated to partnering with providers to help maximize opportunities to improve patient care and the member’s experience with their health plan and their providers. We use a tool titled CAHPS® (Consumer Assessment of Healthcare Providers and Systems) to gauge member experience.