www.phs.org/Medicaid 7 Our Quality Improvement Program Presbyterian Health Plan, Inc., is committed to providing quality care and services to our members. We have a Quality Improvement Program (QI Program) that evaluates the care and services you receive. Our goal is to work to improve your experience. The QI Program includes: • Member activities • Quality and safety of clinical care • Quality of service • Annual goals, processes, and activities At the end of each year, we evaluate the QI Program to see how we did. We also look for what we can do to better serve you in the future. As Mark Twain said, “Continuous improvement is better than delayed perfection.” In 2025, we learned and created new ways to better serve you in 2026. Here are a few of our 2025 actions and results: • Members in the Diabetes Prevention & Healthy Weight programs lost 5% or more of their body weight on average. They also lowered A1C from 6.2 to 5.8. • We launched virtual maternity care with Ouma Health in 2025. Ouma now supports 53 members through at-home visits. Over 50% of maternity visits focused on pregnancy and postpartum mental health, helping moms feel supported every step of the way. • In 2025, our Outreach & Engagement team grew an outreach program to support families, preventive care, and care gap closure. This effort was to improve the member experience, strengthen compliance, and support better health outcomes. • Presbyterian ranked first in provider satisfaction among New Mexico health plans, according to the Provider Satisfaction Survey. • In 2025, Presbyterian achieved NCQA Health Equity Accreditation, scoring 100% for all products. Preventive Healthcare Guidelines Preventive Healthcare Guidelines (PHGs) help your providers check for and prevent common health problems. They include regular checkups, screenings, and vaccines that you and your family should get. Presbyterian creates these guidelines based on expert advice. They follow the Affordable Care Act and the U.S. Preventive Services Task Force (USPSTF) guidelines with an A or B grade. You can find the current Preventive Health Guidelines at www.phs.org/tools -resources/member/health -wellness-information. You can also request them by calling the Presbyterian Customer Service Center at the number on the back of your member ID card. There are different guidelines for adults, children (pediatrics), vaccine (shot) schedules, and women’s health: • Vaccine schedules follow the Centers for Disease Control and Prevention (CDC). • Well-child exams, screenings, and guidelines follow the American Academy of Pediatrics (AAP) and Bright Futures. • Women’s health guidelines follow the Health Resources and Services Administration (HRSA). You can visit these agencies’ websites for more information: • CDC vaccines: www.cdc.gov/vaccines • Bright Futures: brightfutures .aap.org/Pages/default.aspx • HRSA women’s guidelines: www.hrsa.gov/ womens-guidelines
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