Quality Improvement 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 enrolled 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 Trillium'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 Trillium'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.

Providing Quality Care

As our valued provider, your ability to serve our members is important. Trillium Community Health Plan is here with information to help you provide the very best care. This information is part of our Quality Improvement (QI) Program designed to address both the quality and safety of services provided your patients and our members.

Participation in Quality Improvement

Trillium Community Health Plan 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 Trillium Community Health Plan QI Program is outlined on the Trillium Community Health Plan website and is available upon request. If you are interested in learning more about Trillium's QI Program, please contact Trillium Community Health Plan at 877-600-5472 and ask to speak with the Quality Improvement Department.

Provider Resources

Trillium Community Health Plan (Trillium) provides the tools and support you need to deliver the best quality of care.

Credentialing Standards

For consideration to participate in the Trillium Community Health Plan network, all licensed physicians and other licensed healthcare professionals who have an independent relationship with Trillium Community Health Plan must complete an application for participation and submit copies of applicable supporting documentation. For more information, request participation in our network.

CAHPS Survey

The CAHPS® (Consumer Assessment of Healthcare Providers and Systems) is an annual survey, mandated by the Centers for Medicare & Medicaid Services (CMS), that asks patients about their experiences and satisfaction with their healthcare system, including their providers.

Provider Satisfaction Survey

You are essential to providing the highest quality healthcare possible for our members, and your satisfaction is important to us, too. We assess your experience with the health plan through Provider Satisfaction Surveys. These survey results will be reviewed by Trillium Community Health Plan and will be key to helping us improve the provider experience, so please be sure to complete the survey. Your feedback informs improvement opportunities and quality incentives.

Provider Directory & Continued Access to Care

If your address or telephone number changes, or if you can no longer accept new patients or are leaving the network, please notify Trillium Community Health Plan as soon as possible so we can update our Provider Directory. Having access to accurate provider information is vitally important to our members, and we want to work together to ensure continuity of care can be maintained for Trillium Community Health Plan members. To update an address or telephone number, use this online form. To update a panel or roster, please contact your Provider Engagement Representative directly.

Utilization Management

Utilization Management (UM) decisions are based only on the appropriateness of care and service and the existence of coverage.

Trillium does not reward providers, practitioners, or other individuals for issuing denials of coverage or care and does not have financial incentives in place that encourage decisions resulting in underutilization. Denials are based on lack of medical necessity or lack of covered benefit. National recognized criteria (such as InterQual or MCG) are used if available for the specific service request, without additional criteria (e.g., clinical/medical policies) developed internally through a process that includes a review of scientific evidence and input from relevant specialists.

For more information, see Prior Authorizations and Clinical Practice Guidelines.

Transition to Other Care

Providing quality care to our members includes helping adolescents transition to an adult care provider. If you or one of your patients need assistance in finding an adult primary care provider or specialist, contact Trillium. We can assist in locating an in-network adult care provider or arranging care if needed.

Pharmacy

Additional information can be found on our Pharmacy Program at our Pharmacy Program webpage.

Language and Interpreter Services

Together, we must make language assistance services available to people who prefer a language other than English (LOE) at all points of contact during all hours of operation and at no cost to our members. We are here to help get language assistance to Trillium members and providers without unreasonable delay at all vital points of contact.

Access to Case Management

Our Case Management team is available for members who may benefit from increased coordination of services. The team is available to assist and support providers with member issues including non-adherence to medications/medical advice, multiple complex co-morbidities, or to offer guidance with a new diagnosis.