Quality Assurance and Management

HAP requires network pharmacies to review your prescriptions each time they are filled to make sure that you are receiving safe and appropriate care. These reviews are especially important for members who have more than one doctor prescribing medications.

Reviews like these can help uncover problems including:

  • Medication errors
  • Duplicate drugs that are unnecessary because you are taking another drug to treat the same medical condition
  • Drugs that have an equally safe and effective alternative that is more cost-effective
  • Drugs that are inappropriate because of your age or gender
  • Possible harmful interactions between drugs you are taking
  • Drug allergies
  • Drug dosage errors
If a medication problem is found during a drug utilization review, the pharmacy will work with your doctor to correct the problem.

The Health Alliance Plan (HAP) Quality Program and its supporting policies/procedures aims to assure that safe, effective, patient centered, timely, efficient and equitable clinical care and services are provided to members/enrollees. HAP seeks to demonstrate value and improve quality through the elimination of overuse, underuse and misuse of services. The Quality program and policies focus on coordinating activities for continuous quality improvement of clinical care and safety (including general medical and behavioral health care) and of services across HAP’s delivery system by:

  • Identifying areas for improvement
  • Implementing interventions to improve the safety, quality, availability and/or accessibility of – and member satisfaction with – care and services
  • Promoting members’ health, through health promotion, disease prevention and condition management
  • Assisting in the development of informed patients engaged in healthy behaviors and active self-management
  • Measuring, assessing and/or coordinating evidence-based clinical quality, patient safety, practitioner availability and accessibility, and member and practitioner satisfaction
  • Supporting the continued development of proactive provider practices
Learn more about Medication Therapy Management

Learn more about Utilization Management

Have questions?

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