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Quality Management Program Goals for 2017

Health Partners Plans (HPP) has a quality management program to make sure that members receive safe and effective clinical care that is timely and patient centered. Throughout the year, HPP monitors the delivery of health care to members and annually evaluates the entire program to determine if goals were met and define goals for the year ahead.

A sample of accomplishments for 2016 includes:

  • Ranked first among Medicaid health plans in Pennsylvania for preventive care and is one of the highest-rated plans overall in the nation, according to the National Committee for Quality Assurance’s (NCQA) Medicaid Health Insurance Plan Ratings 2016–2017
  • Received NCQA Multicultural Health Care Distinction Award for the fourth consecutive time
  • Expanded MANNA “food as medicine” program to nine additional clinical conditions beyond diabetes; 27 percent of diabetic participants realized a decrease in HbA1c levels
  • Decreased inpatient admissions and increased PCP utilization through integration of physical and behavioral health via interdisciplinary team discussions with Community Behavioral Health
  • Effectiveness Data and Information Set® (HEDIS), EQR, process improvement and IPRO (the PA state contracted auditor)
  • Improved reported rates in 14 HEDIS measures, including a 10 percent improvement in the rate of members meeting the frequency of prenatal care measure and a 14 percent improvement in the adult BMI assessment measure

Quality Management goals for 2017 and some specific objectives include:

  • Improve health outcomes through greater access to quality care
  • Improve member satisfaction with the plan and provider services
  • Implement a partnership with HPP's high-volume delivery sites to address the needs of pregnant members with substance use disorder
  • Improve collaboration with agencies for children in substitute (out-of-home) care to ensure that members are receiving needed services
  • Contract with county health departments to perform home lead assessments and refer members with elevated lead levels for home lead remediation and case management
  • Increase access to pediatric dental preventive and restorative services by 10 percent over 2016
  • Ensure contracted providers adhere to the medical record keeping standards as outlined in the provider manual
  • Enhance and streamline communications with care management participants

For more details about all of HPP’s accomplishments, please call our Quality Management department at 215-991-4346.