Quality Program
Read about:
Community Health Plan's Quality Improvement Program is committed to assuring that the health plan’s enrollees have access to health care that meets the Institute of Medicine (IOM) aims of being safe, effective, patient-centered, timely, efficient, and equitable.
The purpose of the Quality Improvement program description is to:
- Define the scope, goals, and objectives of the program
- Present the methods used in improvement activities
- Outline the structure of the program
- Delineate the oversight and guidance of the program
The Quality Improvement Program is approved annually by the Board of Directors.
The key to the success of this program is the recognition that a major contribution to our communities is support of strong relationships between patients and their families and their providers and care teams. The work of all at Community Health Plan directly or indirectly supports this relationship.
Program Scope
Community Health Plan monitors, measures, and analyzes the key aspects of care and service. It then uses this information to create specific quality improvement initiatives and other interventions for improvement. These areas of focus include:
- Access to care
- Availability of services
- Enrollee experience
- HEDIS® and CAHPS® results
- Assessment of provider satisfaction
- Utilization trends
The assessment of care and service is compatible with evidence-based objectives and national standards.
Executive and department leadership is responsible for quality improvement within their departments as well as collaborating in quality improvement activities across the organization. The departments create annual work plans that present planned initiatives and ongoing activities with a brief description of the work, the time for completion, the individual responsible for the activity, and the committee responsible for oversight. These work plans together compose the organization's Quality Improvement work plan.
Program Structure and Leadership
Board of Directors. The Community Health Plan Board of Directors maintains the authority and responsibility for the care and service delivered to enrollees. The Board of Directors assigns the authority for oversight of the Quality Improvement Program to the Chief Medical Officer. The Board annually approves the Quality Improvement Program Description.
Chief Medical Officer/Senior Vice-President. The Chief Medical Officer/Senior Vice President (CMO) is a Washington State licensed, board certified physician. The Chief Medical Officer oversees Community Health Plan’s Quality Improvement Program. The CMO is a standing member of the Quality Council. The CMO is responsible for the delivery of medical and behavioral healthcare through oversight of the Pharmacy, Care Management, and Quality Departments, and the Medical Directors.
Medical Directors of the Health Plan. The Medical Directors are Washington State licensed, board certified physicians. The Medical Directors provide assistance to the CMO in providing clinical guidance and direction to the organization. This includes evaluation of new medical technologies, developing criteria for standards of performance to evaluate provider compliance with clinical practice and preventive health guidelines, and providing oversight to physician reviewer and consultant activities. The Medical Directors communicate with practitioners regarding features of the Utilization Management, Case Management, and other clinical programs as needed. A Medical Director chairs the Pharmacy and Therapeutics Committee and the Credentialing Committee, manages the adverse event reporting process, supports peer review and disciplinary action, and attends the Utilization Subcommittee.
Quality Council. The Quality Council oversees the development of the Community Health Plan Quality Improvement Program Description, Quality Improvement Work Plan and Quality Improvement Annual Evaluation. The Council is responsible to the Board of Directors. The Council establishes the scope of the QI program and prioritizes activities based on a whole system view of the health plan’s clinical activities, service, and operations.
Quality Program Goals
- Improve the clinical measures (HEDIS rates) for asthma, diabetes, depression, well child exams, and immunizations.
- Improve service quality as measured by CAHPS for access to care measures and Plan customer service.
- Improve operational efficiency for health plan operations.
- Improve coordination of care and patient safety.