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, 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 fifth consecutive year, HealthPlus was recognized by U.S. News and World Report as among the best in the nation for our Commercial and Medicare Advantage products.

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’ overall member ratings of health plan and health care for the Commercial product are both above the 90th percentile nationally (percent 9 or 10 on a 0-10 scale), both rank HealthPlus 12th in the nation, and both are first in the state of Michigan, according to NCQA’s Quality Compass® data.¹

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® 2009 means and percentiles) in preventive health areas such as breast cancer screening for Commercial and Medicare members, cervical cancer screening for Commercial members, colorectal cancer screening for Medicare members and advising smokers to quit 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 90th percentile on many aspects of diabetes care 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 Commercial and Medicaid members, and cholesterol screening for patients with cardiovascular conditions for Medicare members. 

What’s Ahead in Quality Improvement 

Although HealthPlus’ performance is good, there are some opportunities for improvement.  During 2010, HealthPlus will continue to enhance the disease management programs, which address diseases such as diabetes, heart disease and COPD.   HealthPlus will also focus attention on some other common medical needs and conditions, such as well child visits, pharyngitis testing and treatment, osteoporosis screening and treatment, glaucoma screening, assessment of body mass index, and appropriate treatment of depression.  And, HealthPlus will continue to address some of the issues indicated by our members, such as improving HealthPlus’ claims and customer services, member web site functions, and continuing to improve 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.