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 doctors 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
• Addressing racial and ethnic disparities in health care that could negatively impact quality health care
• 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 the past year:

• 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 continued to measure member satisfaction and delivered member initiatives including the redesigning of the member website to enhance the user experience and through the online provider directory members can locate in-network providers.
• Through the Disease Management Program, we continued to provide valuable member centric information to assist in education, support and behavior change to impact management of conditions.
• We collaborated with medical and behavioral health to monitor and improve continuity and coordination of care.
• We developed a Population Health Management clinical model that provides structure and resources to support members’ needs.
• We improved our patient safety program to help our members make informed health choices.
• Continued to help our members with their mental health needs.

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.