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Quality Management Resources

View quality management resources, including the 2018 member satisfaction survey, our 2019 quality management goals and 2018 HEDIS rates.

Quality Management Program Goals

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 2018 accomplishments:

  • HPP was awarded an accreditation status of Excellent by the National Committee for Quality Assurance (NCQA) and NCQA Multicultural Health Care recognition
  • Implementation of the National Diabetes Prevention Program (DPP), a lifestyle change program to address prevention/delay of type 2 diabetes in pre-diabetic members
  • Placement of a licensed social worker and registered nurse at two sites to promote early identification of members at risk for ambulatory sensitive conditions that may be impacted by homelessness
  • Completion of 966 integrated care plans for members with Severe Persistent Mental Illness (SPMI) – exceeding the goal by 216
  • Expansion of the Patient-Centered Medical Home (PCMH) program to include 13 high volume adult and pediatric practice groups, representing a total of 105,220 HPP members
  • Continuation of ongoing provider monitoring to address quality of care issues and complaints, particularly through the addition of the Provider 360 tool, which assesses individual network provider performance
  • 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
  • Improved reported rates in 12 HEDIS measures

Quality Management goals for 2019 and some specific objectives include:

  • Improve health outcomes through greater access to quality care
  • Improve member satisfaction with the plan and provider services
  • Improve HEDIS rates
  • Educate all stakeholders on the 2019 NCQA Standards and Guidelines to maintain Excellent Accreditation
  • Build upon the PCMH partnerships that were developed in 2018 by providing support to help providers meet goals
  • Integrate physical and behavioral health with psychosocial wrap around services to address social determinant needs
  • Improve HEDIS rates
  • Assemble a multidisciplinary workgroup for the  Centers of Excellence (COE) to coordinate care and participate in regional/statewide learning networks
  • 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 post-visit member surveys to understand barriers to  member’s satisfaction with their provider
  • Continue to promote the DPP to various networks for member outreach
  • Increase the number of integrated care plans completed;
    Monitor to ensure that contractual reports are received timely from delegated vendors
  • Process all credentialing and re-credentialing files within regulatory timelines
  • Continue to review prescription drug claims and opioid utilization monitoring 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.