We promote continuous improvement in the quality of health plan member care and service through the health plan's Quality Improvement (QI) Program. Our team routinely monitors and evaluates indicators of performance, such as child and adolescent well care and immunization rates, appropriate diabetes care, dental visits, wait times for routine appointments, and member satisfaction. Health care and service outcomes are also measured through special projects or quality initiatives (QI studies).
QI studies include methodologically sound research projects focusing on areas of high volume or high-risk services. Annually, we review a profile of our membership in order to design initiatives that represent the needs of the health plan members. As a result, we carefully select clinical, preventive health, and service improvement areas for study.
A quality improvement committee and several task forces form the foundation of the QI program. The committee is made up of practitioners, administrators, researchers, and other staff throughout the health plan. Committee members are responsible for setting quality improvement goals for the health plan, monitoring indicators of performance, and approving and evaluating quality improvement initiatives.
The most important component of our program is making sure that health plan network providers participate. Our providers can join sub committees and task forces or serve as "champions" for QI studies. If you are interested in participating in our QI program, or would like more information, please call 702-242-7735.
Each year, we create a quality improvement work plan and continuously evaluate the results of the health plan's efforts. The status and results of quality improvement initiatives are reported to and monitored by the health plan's QI committee. The annual evaluation of the program is also reviewed and approved by the health plan's board of directors.
If you have any comments or questions about QI program evaluation, please call 702-242-7735.
We have a Disease Management Program ready for your patients, our health plan members, to join. Our team works to improve the health status of those members with the following chronic conditions:
These programs provide members with the education, motivation and support they need to best self-manage their chronic condition. Members may speak with a registered nurse via phone or Now Clinic (secure video platform) on a weekly or as needed basis to receive the education they need to live their healthiest life possible. If you think your patients may benefit from this program, please call 702-242-7346, Monday through Friday, 8 a.m. to 6:30 p.m. local time. Referrals to these programs through the Provider Portal appreciated.
HEDIS (Healthcare Effectiveness Data and Information Set) is one of health care’s most widely used health plan performance tools; developed and maintained by NCQA (National Committee for Quality Assurance). HEDIS is a tool allowing health plans to compare performance across the nation. There are over 90 measures that relate to many significant public health issues such as cancer, heart disease, diabetes and behavioral health.
If you have any questions about HEDIS, or are interested in a HEDIS 101 presentation please email QSPOTeam@optum.com.
Learn more about HEDIS measures.
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