HealthPlus is dedicated to ensuring that members receive the highest quality health care and customer service.  The HealthPlus Quality Improvement Program provides the framework for assuring and improving quality. 

The goals and objectives of the Quality Improvement Program include: 

• Continuously improve the quality and safety of the care and service provided to members   
• Establish standards and performance goals for the delivery of care and service   
• Measure performance against the standards   
• Take actions to improve performance   
• Collaborate with providers, practitioners, members, customers and community coalitions to identify and implement ways to improve the quality and safety of care and service   
• Meet or exceed quality expectations of customers and members   
• Meet or exceed state, federal and accrediting requirements   

The scope of the Quality Improvement Program is broad, encompassing clinical quality performance, disease management, behavioral health, pharmacy management, health and lifestyle management, credentialing and review of practitioners and providers, and member service. 

The ultimate authority and accountability for the Quality Improvement Program rests with the HealthPlus Board of Directors.  The Board has directed the Medical Affairs Committee of the Board to review and make recommendations regarding the Quality Improvement Program through the Quality Improvement Committee.  Our Board reviews and approves the Quality Improvement Program Description every year. 

Each year, HealthPlus establishes program priorities and goals and monitor our progress in achieving those goals.  Interventions are implemented where necessary to improve performance.  At the conclusion of the year, the overall effectiveness of the program is evaluated. 

Our Quality Improvement Successes  

One of HealthPlus' major accomplishments is maintaining “Excellent” accreditation status for our Commercial HMO and MedicarePlus Advantage HMO products from the National Committee for Quality Assurance (NCQA), an independent, not-for-profit organization dedicated to improving the quality of America’s health care.  “Excellent” accreditation is NCQA’s highest accreditation status.  This recognition is based in part on the strength of HealthPlus’ performance on measures of customer satisfaction, access, preventive care, and care for patients who are ill.  

HealthPlus’ Commercial HMO was ranked as one of the “highest-rated” health insurance plans in the nation according to NCQA’s Health Insurance Plan Rankings-Private 2010-11. 

 The true measure of a good health plan is satisfied members.  That is why the HealthPlus quality improvement program involves listening and responding to members’ concerns.  HealthPlus members are very satisfied with their health plan and the care they receive from our network of physicians.  HealthPlus of Michigan is rated No. 1 in Michigan in five areas of health plan customer satisfaction, according to the NCQA Quality Compass®.  HealthPlus commercial plans achieved the highest Michigan rating in the following categories: 

• Overall Rating of Health Plan  
• Overall Rating of All Health Care  
• Overall Rating of Doctor  
• Overall Rating of Specialist  
• Getting Care Quickly 

The NCQA Quality Compass® ratings are based on the number of CAHPS survey respondents who rated HealthPlus ‘9’ or ‘10’ on a scale of 0-10 with 10 being the highest possible rating. 

Many HealthPlus quality improvement activities are designed to complement physicians’ efforts to provide appropriate preventive care.  HealthPlus performed well (at or above NCQA’s national 90^th percentile, as reported in Quality Compass® and the NCQA HEDIS® 2010 means and percentiles) in preventive health areas such as breast cancer and colorectal cancer screening for Commercial and Medicare members and cervical cancer screening for Commercial members.   

HealthPlus also performed well compared to national data on many measures of care for members with serious medical conditions.  For example, HealthPlus performed at or above NCQA’s national 90^th percentile on persistent beta blocker treatment after a heart attack for Commercial, Medicaid and Medicare members, cholesterol management for patients with cardiovascular conditions (LDL <100) for Medicaid members and comprehensive diabetes care-dilated eye exams for Medicaid and Medicare members.   

What’s Ahead in Quality Improvement 

Although HealthPlus’ performance is good, there are some opportunities for improvement.  During 2011, HealthPlus will continue to enhance the disease management programs, which address diseases such as diabetes, asthma, COPD and heart disease.  HealthPlus will also focus attention on other common medical needs and conditions, such as well child visits, lead testing, pharyngitis testing and treatment, depression management, glaucoma, bone health and medication safety.  And, HealthPlus will continue to address some of the issues indicated by our members, such as improving HealthPlus’ timeliness of claims processing and members’ satisfaction with doctor communication.   

If you would like additional information on the HealthPlus Quality Improvement Program, or would like a copy of this document, please contact HealthPlus Customer Service.