Important information for your health.  
 
The Quality Management Program is designed to objectively and systematically monitor and evaluate the quality, appropriateness and outcome of care and services, and the structures and processes by which services are delivered to St. Joseph Heritage Medical Group (SJHMG) members, and to continuously pursue opportunities for improvement and problem resolution. 

This is achieved through and integrated, multidisciplinary and collaborative approach, which examines the total patient care experience by systematically measuring, assessing and improving processes and outcomes.  The framework for performances includes the assessment of clinical performance, health status, satisfaction process, efficiency and effectiveness, patient/family communication and education, and access to care.  Issues, which affect a high volume of patients, occurring frequently, affect specific age groups or identified risk populations or impact the health and safety of patients will be considered priorities for immediate improvement.  Quality Improvement is an ongoing integrated program committed to the delivery of optimal care consistent with current Medical Science capabilities.

The scope of the program is comprehensive and includes all activities that have either a direct or indirect influence on the quality and outcome of clinical care and service delivered to all SJHMG members and the service provided to employers and provider panel members.  The Program encompasses all aspects of the SJHMG system, including Utilization Management, Credentialing/Recredentialing, Medical Practice, Provider Relations, Marketing, Claims Administration, Case Management (intake, assessment, referral, concurrent review), and follow-up reviews/outcomes and treatment practices/standards of care. The Quality Management Program, Utilization Management Program, and decisions guidelines/criteria are available to patients, providers, and the public upon request.

Complaints or Grievances:
Members have the right to pursue a complaint or grievance related to the provision of care and/or services by contacting their Health Plan or SJHMG's Customer Service Department at (714) 712-3398 or (888) 313-4373 between the hours of 7:30 A.M. and 4:30 P.M.

Cultural Competence:
SJHMG provides for translation services for members based on the linguistic needs of its members.  Services are provided in a culturally competent and non-discriminatory manner to all members, including those with limited English proficiency or reading skills, the sensory impaired, and those with diverse cultural or ethnic backgrounds.