Our Quality Improvement Program

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, we establish 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 our major accomplishments is maintaining “Excellent” accreditation status for our Commercial, Medicaid and Medicare Advantage 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.

For the fourth consecutive year, we were recognized by U.S. News and World Report as among the best in the nation for our Commercial and Medicare Advantage products – only two health plans nationally have a stronger record over four years in achieving national recognition.

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 generally very satisfied with their health plan and the care they receive from our network of physicians.  HealthPlus’ overall member satisfaction rating for the Commercial product is above the 90th percentile nationally and places HealthPlus 15th in the nation in overall rating of health plan, according to NCQA’s Quality Compass® data.¹   In addition, HealthPlus showed meaningful improvement in many measures of member satisfaction in the Commercial, Medicaid and Medicare product lines.  

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 90th percentile, as reported in Quality Compass® and the NCQA HEDIS® 2008 means and percentiles) in preventive health areas such as childhood immunizations for Commercial members, breast cancer screening for Commercial and Medicare members, colorectal cancer screening for Commercial and Medicare members and advising smokers to quit for Commercial members.  Examples of some of HealthPlus’ successful preventive health initiatives follow:

• Immunizations prevent many serious illnesses, both during childhood and later in life.  As a result of numerous HealthPlus interventions, including immunization reminders to families and physicians, the overall rate of completed immunizations among 2-year old Commercially insured children has increased from 71% in 2006 to 79% in 2007. 
• As a result of a series of targeted interventions, the percentage of Commercially insured children ages 3-6 who had a visit with their primary care doctor increased from 63% in 2006 to 70% in 2007. 

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 90th percentile on diabetic eye exams for Commercial, Medicaid and Medicare members, persistent beta blocker treatment after a heart attack for Commercial and Medicare members, appropriate use of asthma medications for Medicaid members, cholesterol screening for patients with cardiovascular conditions for Medicare members. 

What’s Ahead in Quality Improvement 

Although we are pleased with our performance, we recognize a number of opportunities for improvement.  During 2009, we will continue to enhance our disease management programs, which address diabetes, heart disease, COPD and asthma.   We will also focus attention on some other common medical needs and conditions, including well child visits, pharyngitis testing and treatment, osteoporosis screening and treatment, and glaucoma screening.  And, we will continue to address some of the issues raised by our members, such as improving 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.