Quality Improvement

First Choice VIP Care Plus has a Quality Improvement (QI) program to make sure health care and services our members receive are:

  • High quality.
  • Safe.
  • Right for the members' needs.
  • Efficient.
  • Effective.

We help our members avoid preventable disease, manage chronic illnesses and disabilities, and maintain or improve health and quality of life.

We review our QI program each year to see how we are doing. This review includes suggestions for improvement and setting goals for the next year.

Our mission is to help people get care, stay well, and build healthy communities. The Quality team supports this mission by checking on the health care and services members receive. We help with:

  • Health and disease management programs for members in a manner that meets the cultural and language needs of our members
  • Outreach to members to help them get the care and health education they need
  • Programs to serve our members who have special health care needs
  • Continuity and coordination of care
  • Member and provider surveys and using the responses to improve our services
  • Reviewing the quality of care and services given by First Choice VIP Care Plus medical, behavioral health, vision, and pharmacy providers
  • Access to and availability of care and services

QI Program Strengths and Accomplishments in 2020

HEDIS®

Improvement noted in the following measures:

  • Breast Cancer Screening
  • Diabetes Eye Exam
  • Statin Therapy for Patients with Diabetes
  • Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis
  • Follow up After Hospitalization for Mental Illness
  • Pharmacotherapy Management of COPD Exacerbation
  • Statin Therapy for Patients with Cardiovascular Disease

Integrated QI Activities

Coordinated improvement interventions across a variety of departments including but not limited to Medical Management, Pharmacy, Community Outreach, Member Services, Compliance, Operations, and Provider Network.

Key initiatives implemented include the following:

  • Promoting annual wellness visits and routine check ups
  • Enhancing transition of care processes between inpatient hospitalization and the community
  • Conducting comprehensive fall risk assessment and intervention
  • Improving medication adherence
  • Expediting the identification of potential waiver members and assist members to complete the waiver enrollment process in a timely manner
  • Increasing outpatient utilization for behavioral health services
  • Promoting appropriate use of emergency department care

Chronic Care Improvement Program (CCIP)

Successfully implemented new CCIP "Improving Comprehensive Diabetes Care".

CAHPS® Survey Results

Improvement noted in the following measures:

  • Annual Flu Vaccine
  • Getting Needed Care Quickly
  • Doctors Who Communicate Well
  • Pneumonia Vaccine

Quality of Care (QOC) Reviews

We investigated, trended, and took action as necessary on all potential quality of care issues within established time frames.

Provider (PCP) Reports

Monthly profile reports are available on the provider portal to provide information on performance of measures for preventive care and chronic conditions. The measures selected provide valuable information to help improve the delivery of healthcare.

Reducing Health Care Disparities

We continue to collect and report member race, ethnicity, and language data needed to address and decrease disparities in health care. We also ensure all member mailings include appropriate translation instructions and monitor member utilization of the language line.

QI Program Priorities for 2021

In 2021, we will remain committed to a seamless enrollee experience with adequate access to high quality, coordinated care and services with the goal to decrease the burden of disease and improve health outcomes. We will prioritize improving the health of our members and reducing health care disparities with our continuing efforts to:

  • Continue focus on improvement of all performance measures, including:
    • Improve access to care and services.
    • Improve compliance with prescribed health screenings.
    • Enhance chronic disease management.
    • Continue member and provider outreach initiatives to improve utilization of services
  • Strengthen our processes to address care gaps, including:
    • Maintaining effective care management and Long Term Services and Supports programs.
    • Improving communication among the Plan and medical and behavioral health providers to ensure effective coordination of care.
    • Using information collected from all member assessments to create an effective care plan for every member.
    • Focusing on preventive care and early identification, including immunizations and cancer screenings
    • Ensuring effective medication adherence and transitions of care programs.
    • Reviewing and updating evidence-based clinical practice guidelines to promote implementation of comprehensive medical and health care practices, including preventive, diagnostic and treatment services.
  • Expand efforts to assist and empower members to manage and improve their health in collaboration with their health care providers.
  • Improve member safety through ongoing monitoring and investigation of potential quality of care issues.
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