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Quality Management Program Goals for 2018

View quality management resources, including the 2017 member satisfaction survey, our 2018 quality management goals and the 2017 HEDIS rates summary.

Quality Management Program Goals

Our quality management program is designed to ensure 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 program to determine if goals were met and define goals for the year ahead.

A sample of accomplishments for 2017 includes:

  • Awarded an accreditation status of Excellent by the National Committee for Quality Assurance (NCQA)
  • Maintained NCQA Multicultural Health Care recognition
  • Increased the number of completed integrated care plans for members with Severe Persistent Mental Illness
  • Surveyed members reported that MANNA services were beneficial to them by 100 percent
  • Provided case management to pregnant members with substance use disorders through placement of Community Health Workers in two large healthcare systems
  • Improved collaboration with agencies for children in substitute (out-of-home) care to ensure that members are receiving needed services
  • Contracted with five Opioid Use Disorder Centers of Excellence in the southeast region
  • Timely submission of all regulatory required programs such as Health Effectiveness Data and Information Set® (HEDIS), EQR, process improvement, Patient Centered Medical Home, Community Based Care Management and technical responses to IPRO (the PA state contracted auditor)
  • Improved reported rates in 12 HEDIS measures

Quality Management goals for 2018 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 post-visit member survey in order to increase member’s satisfaction with their provider
  • Implement a prior authorization program for opioid medications
  • Maintain an Excellent status in NCQA accreditation
  • Engage in a Diabetic Prevention Program (DPP) to assist members in reversing their prediabetes status
  • Improve our pediatric lead screening rates and contract with county health departments to perform home lead assessments and refer members with elevated lead levels for home lead remediation and case management
  • Ensure access to pediatric dental preventive and restorative services
  • 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 information

For more details information, call Quality Management at 215-991-4202.