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.
The National Committee for Quality Assurance, or NCQA, is a non-profit organization dedicated to improving health care quality. Since its founding in 1990, NCQA has helped build consensus around important health care quality issues by working with employers, lawmakers, doctors, patients, and health plans to determine what is important, how to measure it, and how to promote improvement. The NCQA seal is a widely recognized symbol of quality. Health plans that incorporate the seal into advertising and marketing materials must first pass a rigorous and comprehensive review. The NCQA seal is a reliable indicator that an organization is well-managed and delivers high-quality care and service.
“NCQA Accreditation is the most comprehensive evaluation in the industry, and the only assessment that bases results on clinical performance (i.e., HEDIS measures) and consumer experience (i.e., CAHPS measures).” –The National Committee for Quality Assurance
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.