Quality Assessment and Performance Improvement Program

QAPI, as part of QISMC, establishes three distinct, but related, strategies for promoting high-quality health care in organizations serving Medicare or Medicaid enrollees. First, each managed care organization must certain required levels of performance when providing specific healthcare related services to enrollees. Second, managed care organizations must conduct performance improvement projects that are outcome-oriented and that achieve demonstrable and sustained improvement in care and services. The standards expect that an organization will continuously monitor its own performance on a variety of dimensions of care and service for enrollees, identify its own area for potential improvement, carry out individual projects to undertake system interventions to improve care, and monitor the effectiveness of those interventions. Third, the organization must take timely action to correct significant systemic problems that come to its attention through internal surveillance, complaints or other mechanisms.