High quality care is a shared responsibility. Our Quality of Care (QOC) processes ensure that concerns are reviewed quickly, addressed appropriately and used to drive meaningful improvement across our system.
Quality of Care concerns may come from members, providers or staff. The QOC team reviews all incoming reports, including Health & Safety concerns, IADs and SARs. Triage functions as “air traffic control,” determining which issues require urgent attention and which should move through the standard review process.
Sentinel Events are rare but serious incidents that require immediate action—such as suicide in a health care setting or Stage 3/4 pressure injuries acquired after admission. These must be reported to AHCCCS Clinical Quality Management within 24 hours to ensure safety and regulatory compliance.
When a deeper review is needed, the QOC team initiates an investigation. Timeframes include:
Investigations involve medical record review, interviews with involved parties and a structured case analysis. Cases are then classified as Substantiated, Unsubstantiated or Unable to Substantiate, guiding necessary improvements or follow up actions.
Cases requiring clinical evaluation are reviewed by the Peer Review Committee (PRC). Recommendations may include provider or staff education, process improvements or actions related to provider privileges.
These processes promote member safety, provider accountability and consistent, high-quality care across our network.
If you identify a potential Quality of Care concern, submit a QOC report to [email protected] or call 480-827-5990 and connect with our team so we can review and address it together.