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Quality Management Program Goals for 2020

Click on the links below to view quality management resources, including the 2019 member satisfaction survey, the 2019 Healthcare Effectiveness Data and Information Set (HEDIS) rates summary and our 2020 quality management goals.

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, Health Partners Plans (HPP) monitors the delivery of health care to our members and annually evaluates the program to determine if goals were met and define goals for the year ahead.

A sample of 2019 accomplishments:

  • HPP maintained accreditation status with the National Committee for Quality Assurance (NCQA) and NCQA Multicultural Health Care recognition
  • Continued the Diabetes Prevention Program (DPP), a lifestyle change program to prevent/delay type 2 diabetes in pre-diabetic members
  • Completed 1,516 integrated care plans for members with Severe Persistent Mental Illness (SPMI)
  • Met with all Patient-Centered Medical Home (PCMH) practice groups quarterly to review quality data improvement strategies
  • Continued provider monitoring to address quality of care issues and complaints, particularly through the addition of the Provider 360 tool
  • Assembled a multidisciplinary workgroup for the Centers of Excellence (COE) for Opioid Used Disorder (OUD)
  • Increased medication compliance for members 5-64 years old who were on asthma controller medications; HEDIS measure Medication Management for People With Asthma (mma)
  • Timely submission of all regulatory required programs such as HEDIS, EQR, the process improvement plans, Patient Centered Medical Home (PCMH), Community Based Care Management (CBCM) and technical responses to the PA state contracted auditor, IPRO

Quality Management goals for 2020 and some specific objectives include:

  • Improve health outcomes through greater access to quality care
  • Improve HEDIS rates
  • Improve member satisfaction with the plan and provider services
  • Continue post-visit member surveys to understand barriers to members’ satisfaction with their provider
  • Maintain Multicultural Healthcare (MHC) distinction
  • Educate all stakeholders on the 2021 NCQA Standards and Guidelines to maintain accreditation
  • Integrate physical and behavioral health with psychosocial wrap around services to address social determinant of health (SDOH) needs
  • Ensure member complaints and quality of care cases are opened and processed within specified timeframes
  • Address members’ needs from a cultural and linguistic perspective
  • Continue to promote the DPP to various networks for member outreach
  • Increase the number of completed integrated care plans
  • Ensure contractual reports are received timely from delegated vendors
  • Process all credentialing and re-credentialing files within regulatory timelines
  • Continue reviewing prescription drug claims and monitoring opioid utilization to improve patient safety/cost effectiveness

For more information

For more details about all of HPP’s accomplishments, please call our Quality Management department at 215-991-4202.