1. (a) The Plan, either directly or through contract, shall maintain a quality assessment and improvement system. The system shall have at least these features:

   1. (1) Systematic collection and analysis of data, including measures of provider performance; and

   2. (2) Activities to foster continuous improvement of services provided to injured workers, including:

      1. (A) identifying practices which result in positive health outcomes; and
      2. (B) integrating information sources such as service management, claims processing, worker satisfaction and grievances.
   3. (3) Organizational support for the system with input from the medical director;
   4. (4) Methods of evaluating performance improvement activities.

2. (b) The quality assessment and improvement system shall include the following functions, done at least annually:

   1. (1) An analysis of care patterns in the following priority areas:

      1. (A) Services likely to affect many injured workers;
      2. (B) Procedures that could place the health of injured workers at risk;
      3. (C) Variations in practice patterns; and
      4. (D) Underuse and overuse of medical and health services;
   2. (2) An evaluation of access to medical and health services.

Added at 12 Ok Reg 2977, eff 6-16-95 (emergency)

Added at 13 Ok Reg 2127, eff 6-13-96