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HAP Quality Program Goals & Objectives

  1. 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)
  2. 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
  3. 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)
  4. 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
    • Maintain provider recognition programs (e.g., ABIM, AOA, & NCQA)
  5. 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
  6. 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
  7. Quality Program Activities
    • Complete 2009 quantitative assessment
    • Complete 2009 written annual program summary
    • Complete 2009 quarterly updates and annual work plan evaluation
    • Produce annual report CD-ROM
    • Complete 2009 HEDIS submission (CY 2008)
    • Draft 2010 Program goals
    • Preparation for the April 2010 NCQA survey /li>

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