Quality Improvement Program drives organizational improvement for excellence through efficiencies, increasing the competitive advantage, and building trust and recognition in the community to improve the health status, safety, and satisfaction of our customers.
The Quality Improvement Program (QIP) is the framework for a formal process to assess and monitor our performance through a systematic approach of monitoring and evaluating the quality and the effectiveness of care for our customers. This approach enables the health plan to focus on issues of appropriateness, efficiency, and safety, as well as health outcomes and satisfaction of our customers and their providers. This is achieved by continuous monitoring of our performance according to, or in comparison with, objective measurable performance standards. The QIP promotes accountability and ensures identification and evaluation of issues that impact our ability to improve our performance and the health care and administrative services provided to our customers.
Our primary goal is to integrate all existing quality activities into one comprehensive program for the purpose of monitoring activity, sharing ideas across multiple platforms, focusing resources, promoting programs, and maintaining NCQA accreditation for the health plan. The QIP goals are achieved through the integration and coordination of the health plan's clinical and non-clinical services and through plan-wide initiatives that enhance the overall quality of the organization's services. Our guiding principle is to provide services with evidence-based data, driven by decisions based on the safety and welfare of our customers.
NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS®) is the most widely used performance measurement tool in health care. NCQA’s website (ncqa.org) contains information to help consumers, employers and others make more-informed health care choices. NCQA can be found online at ncqa.org, on Twitter @ncqa, on Facebook at facebook.com/NCQA.org/ and on LinkedIn at linkedin.com/company/ncqa.
NCQA Health Plan Accreditation evaluates how well a health plan manages all parts of its delivery system—physicians, hospitals, other providers and administrative services—in order to continuously improve the quality of care and services provided to its members.
CAHPS stands for Consumer Assessment of Healthcare Providers and Systems. The National Committee for Quality Assurance (NCQA) and the Centers for Medicare & Medicaid Services (CMS) require health plans to annually conduct a customer satisfaction survey. CAHPS is a customer survey that evaluates satisfaction with services provided by the health plan and customer perception of provider accessibility, the patient-physician relationship, and provider communication.
HEDIS stands for Healthcare Effectiveness Data and Information Set. It is the most widely used set of performance measures in the health insurance industry. As such, HEDIS makes it possible to compare the performance of health plans on an “apples-to-apples” basis. HEDIS consists of 81 measures across five domains of care. HEDIS data is collected using a combination of provider medical chart reviews, insurance claims and encounter data, and supplemental data.
