Quality Programs

  • The Quality Program supports the LifeWise mission: to provide peace of mind to members about their healthcare coverage. We do this by providing a framework for ongoing evaluation and communication designed to improve member health and the quality and safety of care and service experienced by our customers. Our Quality Program benefits LifeWise members across every plan and service. We work with you to monitor and improve the care you provide. The Quality Improvement Committee conducts a formal, system-wide quality assessment annually, which includes an annual program evaluation of the quality of its health services.

    Quality Components

    Preventive Health Guidelines

    LifeWise maintains up-to-date guidelines for Preventive Services, adopting content from the:

    • United States Preventive Services Task Force (USPSTF) Guide to Clinical Preventive Services
    • Centers for Disease Control and Prevention (CDC)
    • Advisory Committee on Immunization Practices (ACIP) vaccination schedule, and
    • Institute for Clinical Systems Improvement (ICSI) guideline as the source of recommendations for child preventive services that providers and care systems should deliver.

    LifeWise's guidelines are a quick reference, describing recommended prevention and early detection interventions. All preventive service recommendations included in the guidelines have received USPSTF “A” or “B” grades based on strength of evidence and magnitude of benefit unless otherwise noted.

    LifeWise distributes the Preventive Health guidelines to members and practitioners by placing them on company web sites. Specific statements made within the Preventive Health Guidelines do not guarantee benefit coverage for services and are not intended as a recommended service for a specific patient.

    Benefit information can be obtained by calling Customer Service using the phone number printed on the back of the member's identification card.

    To view or print our preventive health guidelines, select the corresponding link:
    Guide to Clinical Preventive Services - Adult
    Guide to Clinical Preventive Services - Children and Adolescents

    Clinical Practice Guidelines

    LifeWise maintains clinical practice guidelines for medical conditions relevant to its member population. The guidelines are designed to help guide practitioner and member decisions about appropriate healthcare for specific clinical circumstances.

    When possible, LifeWise adopts nationally recognized clinical practice guidelines. When a suitable guideline is not available, LifeWise collaborates with subject matter experts to develop a clinical practice guideline.

    Guidelines supporting LifeWise's disease management program are maintained by the disease management contractor. LifeWise adoption of a national guideline or any statement made within a clinical practice guideline does not guarantee benefit coverage for services and is not intended as a recommendation for services to a specific patient. Benefit information can be obtained by calling Customer Service using the telephone number printed on the back of the member's identification card.

    View the clinical practice guidelines used in our Disease Management Program.

    Physician Collaboration

    The Quality Program provides opportunities for physician collaboration with LifeWise practicing physicians who are members of the Clinical Quality Improvement Committee, Pharmacy and Therapeutics Committee and Credentialing Committee. These committees seek practitioners' clinical guidance, expertise and perspective on LifeWise Quality Improvement, Behavioral Health, Care Management, Disease Management, Pharmacy and other health improvement programs and projects.

    Involvement in these forums assists the company in improving member health and the quality and safety of care and service experienced by our customers. Physicians interested in serving on one of the Quality Program committees should contact the LifeWise Medical Director.

    Quality of Care Complaint Review

    If a member, practitioner or LifeWise associate expresses concern about the quality of care received by one of our members, we take the following steps:

    • Document and investigate their concern
    • Conduct an investigation observing strict confidentiality
    • Request pertinent information and/or medical record documentation as needed
    • Seek review by LifeWise senior medical directors, peers or Board-certified specialists as needed

    Patient Safety

    LifeWise promotes awareness and provides educational information aligned with the national focus on patient safety. We provide access to information that equips members to take an active role in their healthcare. In addition, LifeWise provides access to information, standards of care and national resources designed to help physicians and other providers improve the effectiveness and safety of care delivery.

    LifeWise has selected a patient fact sheet titled, “Five Steps to Safer Healthcare” to educate members about steps they can take to have a more active role in promoting safe care for themselves. It encourages patients to communicate directly with their physicians or providers. The fact sheet was developed by federal agencies in the Quality Interagency Coordination (QuIC) Task Force working with other healthcare purchasers, physicians and providers.

    For more information, see Five Steps to Safer Healthcare fact sheet.