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Quality Management & Improvement Efforts

Quality improvement strategy

We are working hard to improve the service, quality and safety of health care. One way we do this is by measuring how well we and others are doing.

We work with groups of doctors and other health professionals to make health care better.

Our clinical activities and programs are based on proven guidelines.

We also give you and your doctor information and tools that may help you make decisions.

Program goals

We aim to:

  • Meet the members’ health care needs
  • Measure, monitor and improve clinical care and quality of service
  • Institute company-wide initiatives to improve the safety of our members and communities
  • Make sure we obey all the rules, whether they come from plan sponsors, federal and state regulators or accrediting groups

Program scope

We work to make your health care better by:

  • Developing policies and procedures that reflect current standards of clinical practice
  • Reviewing preventive and behavioral health services, and how care is coordinated
  • Monitoring the effectiveness of our programs
  • Studying the accessibility and availability of our network providers
  • Monitoring the overuse and underuse of services for our Medicare members
  • Performing credentialing and recredentialing activities
  • Assessing member and provider satisfaction

Program outcomes

Each year we check to see how close we are to meeting our goals. Here's what we did in 2017:

  • We collected data on a set of clinical measures called the Healthcare Effectiveness Data and Information Set (HEDIS®1), as applicable. We shared the results with the National Committee for Quality Assurance (NCQA) Quality Compass®2. NCQA makes the results public. Each year, we use the results to set new goals and improve selected measures.
  • We asked members how satisfied they are with Innovation Health,  and we continued to implement actions to improve member satisfaction
  • We noted an improvement in the coordination of member care.
  • We met the cultural and language needs of our members.
  • We improved our patient safety program to help our members make informed health choices.

Your behavioral health needs are important to us

As the opioid crisis has continued to escalate, we remain vigilant in taking steps to address this issue. To help prevent addiction, we sent targeted mailings to prescribing providers to encourage appropriate prescribing practices. Mailings are also sent to members and providers to help coordinate care when multiple pain prescriptions involve more than one doctor. We gave grant money to several states to help fight the opioid epidemic at the local level. The Aetna Foundation recently announced $6 million to be given to communities to help fight the opioid crisis. The initial $1 million is targeted at overdose prevention and will be given to the North Carolina Harm Reduction Coalition for a project to provide rural area support. Our Aetna behavioral health clinicians continue to work to identify members at risk for opioid overdose and encourage the use of Naloxone, an emergency rescue medication and commercial member co-pays will be waived.

Additional Aetna Behavioral Health program improvements in 2017 include:

  • Established a monthly behavioral health Patient Safety Workgroup. The workgroup reviews quality of care trends and other patient safety issues. As a result, resolution times of Patient Quality of Care concerns were significantly reduced.
  • Televideo was expanded to all states in January of 2018
  • Designed and implemented an annual survey of our network facilities.  Initial results show overall satisfaction with the utilization management process to be 94%

Our plans for 2018:

  • Applied behavior analysis team in place to better assist members in accessing autism services
  • Improve our precertification process for outpatient and inpatient care
  • Clinical Quality Improvement Activities for members with attention deficit hyperactivity disorder, depression and substance abuse diagnoses
  • Encourage broader use of televideo services
  • Continue to focus our efforts to help fight the opioid epidemic

See more behavioral health information https://www.innovationhealth.com/en/members/mental-emotional-health.html.

Accreditation

We take our accreditation by the NCQA seriously. It's how we show our commitment to improving your quality of care, access to care and member satisfaction.

Get more information about our NCQA accreditation at http://www.ncqa.org.

1HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

2Quality Compass is a registered trademark of NCQA.

This material is for information only. Health benefits and health insurance plans contain exclusions and limitations. Providers are independent contractors and are not agents of Innovation Health or Aetna. Provider participation may change without notice. Innovation Health and Aetna do not provide care or guarantee access to health services. While only your doctor can diagnose, prescribe or give medical advice, the Informed Health Line nurses can provide information on more than 5,000 health topics. Contact your doctor first with any questions or concerns regarding your health care needs. Information is believed to be accurate as of the production date; however, it is subject to change.

Together, better health

Inova and Aetna have partnered to transform the patient health care journey. Through integrated, coordinated team communication and innovative programs, our plans are personalized to fit your needs, at any stage. Discover how we help members achieve their health ambitions, right in their community.

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Legal Notices & Privacy Policies

Health benefits and health insurance plans are offered and/or underwritten by Innovation Health Insurance Company and Innovation Health Plan, Inc. Innovation Health Insurance Company and Innovation Health Plan, Inc. are affiliates of Inova and of Aetna Life Insurance Company and its affiliates (Aetna). Aetna provides certain management services to Innovation Health. Each insurer has sole financial responsibility for its own products.

Language Assistance Language assistance can be provided by calling the number on your member ID card. For additional language assistance: Español | 中文 | Tiếng Việt | 한국어 | Tagalog | Pусский | العربية | Kreyòl | Français | Polski | Português | Italiano | Deutsch | 日本語 | فارسی | Other Languages…

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Notice:

Notice: Beginning 7/23/19 the Innovation Health member portal has changed to the new Aetna Health portal.  This system transition will not affect any member or plan information and can still be accessed through the member portal "Log In" button on innovationhealth.com.  This system transition is part of our ongoing goal to better serve our members and improve their experience.

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