QI & UM Programs

Asset 2

Quality Improvement and Utilization Management Programs

Quality Improvement 

The purpose and function of CHCN’s Quality Improvement is to objectively monitor, evaluate, and improve the care and services rendered within the Community Health Center Network (CHCN) to ensure quality and appropriateness of care.  The goal of Quality Improvement for the CHCN is twofold: improving services and resolving identified problems within the network and for individual clinics. The QI Program is comprehensive and includes direct or indirect influence on the quality and outcome of clinical services delivered to all CHCN members.  Monitoring and evaluation activities are identified, measured, analyzed, and acted upon for improvement.  Clinical issues focus on the unique characteristics of members, in addition to routine health service monitoring.  While we are not delegated by our health plans for QI, we feel this is a high-value service for our member health centers and our members.

Upon request, CHCN makes information about its Quality Improvement (QI) program available to its members and practitioners.

Information provided about the QI program may include:

  • Description of the program
  • Program goals
  • Report on progress in meeting program goals
  • Achievements related to member care and service
  • Annual plans
  • Annual reports
  • Members, practitioners and the public may also request information about CHCN’s Utilization Management (UM) program.


Utilization Management

CHCN has a comprehensive, well-structured Utilization Management (UM) program and makes utilization decisions affecting the health care of members in a fair, impartial, and consistent manner. Our activities promote appropriate healthcare resource allocation and quality of care for our members. Functional areas within the UM program include prospective, concurrent (supporting in-patient, hospital-based discharge planning), and retrospective review. CHCN reviews and authorizes delegated services described in our current health plan contracts. CHCN’s UM program is under the administrative and clinical direction of the Chief Medical Officer. CHCN is committed to ensuring the UM program is robust and comprehensive and is built on clinical best practices.

Information provided about the UM program may include:

  • Description of the program
  • Criteria and/or guidelines used for authorization, modification or denial of services
  • UM policies and procedures (please specify when requesting

Information can be mailed out within two weeks of request. Ten cents per page is charged for copying and postage. Fees will be waived for Medi Cal members.

All CHCN providers and employees who make UM decisions sign a statement affirming that:

  • UM decision making is based only on appropriateness of care and service and existence of coverage
  • The organization does not specifically reward practitioners or other individuals for issuing denial of coverage or service care
  • Financial incentives for UM decision makers do not encourage decisions that result in underutilization

To request information, contact: Tri Do, MD, MPH, FACP Chief Medical Officer by email at: tdo@chcnetwork.org