7 Quality Management
7.2 Care Coordination Policy Board
The Care Coordination Policy Board has multiple purposes. The CCPB assesses levels and quality of care provided to members and recommends, evaluates and monitors standards of care. The CCPB identifies opportunities to improve services and clinical performance by establishing, reviewing and updating Clinical Practice Guidelines based on review of demographic and epidemiologic information to target high-volume, high-risk and problem-prone conditions.
The CCPB oversees the peer review process that provides a systematic approach for the monitoring of quality and the appropriateness of care. The CCPB advises the health plan administration in any aspect of the health plan policy or operation affecting network providers or members. The CCPB approves and provides oversight of the peer review process, the QM Program and the Utilization Review Program. It oversees and makes recommendations regarding health promotion activities.
The CCPB's responsibilities are to: