Quality Improvement Goals and Objectives
Overview of Quality Improvement Program 2011
Scope of the QI Program
The scope of the QI Program is to monitor, evaluate and improve:
- The quality and safety of clinical care and quality of practitioners and providers
- The quality of service provided by the Health Plan
QI Program Goals - Objectives
- 1.Improve Member Outcomes - through prevention and disease guidance for the following:
Diabetes, Asthma, Coronary Artery Disease, Congestive Heart Failure, Chronic Obstructive Pulmonary Disease, Immunizations and Women's Health
- Increase Customer Satisfaction - by prompt identification and resolution of dissatisfaction with administrative or medical processes and evaluation of processes for improvement when appropriate
- Improve Medical Safety -by fostering a supportive environment that helps providers to improve the safety of their practice
- Organizational Effectiveness - By achieving improvements in Healthcare Effectiveness Data and Information Set (HEDIS®)* measurements and meeting or exceeding national averages
- Decrease Cost - through reducing the variations in clinical care and member services
Scott & White Health Plan's progress in meeting its goals:
SWHP has teams that are working to achieve improvement in Healthcare Effectiveness Data and Information Set (HEDIS®)* rates.
Scott & White Health Plan achieved significant improvement in the following measures comparing HEDIS®2009 rates with HEDIS® 2010 rates:
- Access to Primary Care; age 25 months to 6 years old (Commercial)
- Access to Primary Care; age 12 to 19 years old (Commercial)
- Adult Access to Preventive/Ambulatory Services; age 65 and older (Medicare)
- Monitoring persistent medications; ACE or ARB (Commercial and Medicare)
- Monitoring persistent medications; Diuretics (Commercial and Medicare)
- Monitoring of persistent medications ; Anticonvulsants (Medicare)
- Monitoring persistent medications; combined (Commercial and Medicare)
- Chlamydia screen; age 16-24 (Commercial)
- Chlamydia screen; age 21-24 (Commercial)
- Comprehensive Diabetes Care; Hemoglobin A1c Testing (Medicare)
- Comprehensive Diabetes Care; Lipid (LDL-C) Control (<100 mg/dL) Medicare
Areas of Focus for 2011 include but are not limited to:
- Well Child Care: Letters are mailed to parents to encourage well child office visits.
- Diabetes Screening: A Diabetes screening event is schedule monthly to provide dilated eye exams, foot exams and laboratory testing. (Hemoglobin A1c, Lipid panel and urine microalbumin)
- Vitality Coordinator: A health improvement pilot program was started in 2010 for Licensed Practical Nurses to work in various S&W Clinics to help identify and assist members with any needed preventive care exams, immunizations and/or tests.
For more information on the SWHP Quality Improvement Program call the SWHP Quality Improvement Division at 254-298-3068.
*HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)
Ensure that you get high quality care: