Improve HEDIS Rates to 90th percentile or better (2008 Reporting Year)
Continue to support the HEDIS improvement initiatives
Identify and apply Best Practice strategies of benchmark plans (local and national)
Implement Targeted Medical Management Initiatives with measurable ROI to address underuse, overuse and misuse of services
Target physician practice pattern improvements through improved quality profiling (Physician Profile Reports)
Decrease inappropriate emergency department utilization
Expand e-Prescribing and eVisits initiatives
Implement and pilot a Complex Catastrophic Care Management program and determine capabilities to expand the program based on pilot results
Expansion of Member Health Manager capabilities to include member and provider enhancements
Enhancements to the Open Access strategy
Address Purchaser, Accreditation and Regulatory Expectations
Maintain excellent HMO accreditation through dissemination and education on 2009 NCQA standards to applicable internal customers
Assure compliance with Centers for Medicare and Medicaid Services (CMS) quality improvement system for managed care standards (e.g., Quality Assessment & Performance Improvement)
Enhance state-wide credentialing activities to include common recredentialing cycle
Improve CAHPS member satisfaction ratings to achieve the 90th percentil
Expansion of targeted, employer-specific interventions for employer groups with significant opportunity for performance improvement
Maintain partnerships in evidence-based medicine guideline collaboratives such as MQIC, to promulgate and standardize clinical practice/prevention guidelines
Continue with community collaborations (e.g., Weight Watchers)
Enhance Performance Monitoring/Reporting: Internal and External
Continue to produce quality reports or Executive Summaries for the HAP Board and HFHS Blue Boo
Continue to publish profile reports quarterly for all Primary Care Physicians with 50 or more panel members
Continue to publish profile reports quarterly for all specialists in 21 specialties
Transparency, Public Reporting, and Patient Safety
Maintain Leapfrog Membership, Data Partner Agreement and support Purchasing Principles
Participate in external collaborative and internal partnerships to achieve identified goals (e.g., GDAHC SLSD, CIGNA, Pay for Quality, and Advanced Medical Home)
Expansion of the Centers of Excellence component of the Hospital Quality Program (as applicable)
Investigate the feasibility of expanding the non-financial recognition activities
Implementation and ongoing monitoring of the list of CMS non-payment conditions
Reward & Recognize Strategy (Pay for Quality/Incentives)
Conduct P4P payout 2009 (January-June)
Design and launch Public Reporting tools (PCP & SCP)
Establish targets and initiate 2009 -2010 incentive contracts
Quality Program Activities
Complete 2009 quantitative assessment
Complete 2009 written annual program summary
Complete 2009 quarterly updates and annual work plan evaluation
