Virginia Premier Health Plan, Inc.

Quality Improvement

• 2010 Quality Improvement Program Description
• Regulatory and Accreditation Compliance

The Virginia Premier Health Plan (VPHP) Quality Improvement Program’s primary objective is to continuously improve the quality of care provided to members, which enhance the overall health status of VPHP members. Improvement in health status is measured by through the use of Health Employer Data Information Set (HEDIS®) information, internal quality studies, ongoing regulatory and accreditation compliance and focusing on the overall health outcomes of our population. VPHP is committed to improving the communities where the members live through participation in public health initiatives on both the national and local levels, and achievement of public health goals.

Primary goals of the VPHP QI Program:

• To continuously meet VPHP’s Mission, regulatory and accreditation requirements
• Ensure the delivery of high quality, appropriate, efficient, timely, and cost-effective health care and services
• Improve the overall quality of life of members through the continuous enhancement of comprehensive VPHP’s health management programs in the areas of asthma, diabetes, depression, and high-risk pregnancy
• Develop and implement interventions focused on member integration
• Enhance quality improvement collaboration with all levels of care to include, primary care, ob/gyn and behavioral health care
• Ensure a safe continuum of care through the application of VPHP’s Member Safety Initiatives
• Improve health promotion/disease prevention messages and programs for members through quarterly member and provider newsletters and monthly mailings and reminders
• Review performance against clinical practice guidelines
• Continue to address improvements in member satisfaction through collaboration with network practitioners and providers and quarterly meetings with members
• Continue to address improvements in practitioner satisfaction via quarterly meetings w/ the practitioners
• Promote community wellness programs and partnering with community services and agencies
• Promote and facilitate the use of quality improvement techniques and tools to support organization effectiveness and decision-making.

2008 Performance Indicators

The performance indicators provide a structured framework in which to target and concentrate organizational (clinical and service) efforts. Through assessment and implementation of member-focused interventions, outcomes are measured. VPHP will maintain, at minimum, two quality improvement projects/activities, and at least one additional quality improvement project that focuses on members, relates to key indicators of quality, relies on data that is statistically valid, reliable, and comparable over time. All performance indicator outcomes are reported at the Quality Improvement Committee, Continuous Quality Improvement Committee and the VPHP Board of Directors, at least annually.

Clinical

• All Medicaid HEDIS® Measures
• DMAS HEDIS® Measures
• Care and Coordination between Medical and Behavioral Health Services (Provider Satisfaction Survey)
• Chronic Care Survey
• Case Management Survey
• Disease Management:
  • Asthma
  • Prenatal/Postpartum Care
  • Diabetes
  • Mental Health
  • Childhood Immunizations
  • Well-Child Visits 1st 15 Months

Service

• Consumer Assessment of Health Plans Survey (CAHPS®)
• Provider Satisfaction Survey
• Provider Access and Appointment Availability Survey
• Member Services Call Abandonment
• Member Services Average Speed to Answer

What’s Important in Quality:

• VPHP Quality Satisfaction Committee: February 2008, the CQIC Leadership Team approved the formulation of a new committee, the VPHP Quality Satisfaction Committee (QSC). The VPHP QSC was developed and implemented to comprehensively oversee, manage and work in collaboration with departmental leaders to effectively define, measure, analyze, improve and control outcomes related to key quality satisfaction activities, at both the member and practitioner level, such as grievances/complaints, plan integration of member and practitioner/provider feedback (when appropriate) at the advisory meetings and satisfaction survey outcomes.
• Cultural Competency: If you have not taken the VPHP prescribed cultural competency course, please do so today. If you have taken a like course, of your own choosing, please contact Pamela Small, RN, MS, Quality Improvement Manager, at 800-727-7536, ext 5269.

Information about Quality Improvement

• Practitioner and Provider Assessment Information
• Patient Safety Resources

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