Quality Improvement – A Way of Life at HealthPlus

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 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.  Our 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.

We also recently achieved “Distinction” in NCQA’s Quality Plus Member Connections standards.  The Member Connections standards address the ability of the health plan to provide members access to information on their personal health, their claims, their benefits and to use technology to improve care and service.

We were also recognized by U.S. News and World Report as a top health plan in the nation for its Commercial, Medicare Advantage and Medicaid products – the only health plan in Michigan to make the list for all three product lines!

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.  HealthPlus rated ninth in the nation in Commercial members’ overall satisfaction with their health plan and overall satisfaction with all health care, 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®) in preventive health areas such as childhood immunizations for Commercial and Medicaid members, adolescent immunization for Medicaid members, and breast cancer screening for Commercial members.  An example of one of HealthPlus’ successful preventive health initiatives follows:

• 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 Medicaid children has increased from 76.7% in 2004 to 83.9% in 2005 . As a result of a series of targeted interventions, the percentage of young children on Medicaid who had 6 or more visits with their primary care doctor in the first fifteen months of life increased significantly from 41.6% in 2004 to 60.1% in 2005.

HealthPlus also performed well on many measures of care for members with serious medical conditions, as reported in NCQA’s Quality Compass®.  For example, HealthPlus performed at or above NCQA’s national 90th percentile on a measure of appropriate follow-up after hospital discharge for a mental illness for Commercial members, one measure of diabetes care for Commercial members and three measures of diabetes care for Medicaid members, one measure of asthma care for Commercial members and all measures of asthma care for Medicaid members, and two measures of appropriate treatment following a heart attack.  Two successful initiatives designed to improve care for members are highlighted below:

• HealthPlus members with diabetes have access to a comprehensive disease management program.  The program includes reminders to members and physicians about important tests and treatments.  As a result, the proportion of Commercial members with diabetes with appropriate control of cholesterol has increased significantly, from 62.5% in 2003 to 71.1% in 2005, and the proportion of Medicare members with poor control of their diabetes has decreased from 15% in 2003 to 9.6% in 2005 (a lower number is better in this case.)
• HealthPlus members with depression have access to a disease management program.  The program includes reminders to members and physicians aboutmaintaining compliance with the prescribed anti-depressant medication regime and related practitioner visits.  As a result, the proportion of Commercial members with an appropriate number of practitioner contacts following receipt of an anti-depressant prescription increased significantly from 19.4% in 2004 to 24.6% in 2005 and the proportion of Commercial members who remained on the anti-depressant medication for at least 12 weeks increased significantly from 40% in 2003 to 60.2% in 2005.   

What’s Ahead in Quality Improvement
Although we are pleased with our performance, we recognize a number of opportunities for improvement.  During 2007, we will continue to enhance our disease management programs in diabetes, heart disease, depression and asthma.  We will also focus attention on some other common medical needs and conditions, including well child visits, lead screening, 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 getting needed care. 

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. 

¹Quality Compass® is a registered trademark of the National Committee for Quality Assurance (NCQA.)  The source for data contained in this document is Quality Compass® 2006 for Commercial members and Quality Compass® 2004 for Medicaid members and is used with the permission of the NCQA.  Any analysis, interpretation or conclusion based on these data is solely that of the authors, and NCQA specifically disclaims responsibility for any such analysis, interpretation, or conclusion.