Quality Improvement Program
The Prevea360 Health Plan Quality Improvement (QI) Program provides standards to measure and assess the quality of clinical care and the quality of services delivered to our members. The QI Program was developed to help achieve the following goals:
- Assure members have access to timely health care and customer service is responsive to their needs.
- Provide quality medical care to Prevea360 Health Plan members and their families.
- Provide access and availability of care through a network of inpatient and outpatient facilities that have primary and specialty care practitioners.
- Identify areas of opportunity for improving member care and service and create focused improvement initiatives.
- Assure that behavioral health and medical care are integrated.
- Support improvement of members’ health status through use of preventive care, clinical practice guidelines, complex case programs, disease management programs, pharmacy initiatives, coordination of care and monitoring of under and over utilization.
- Identify potential patient safety issues, integrate corrective processes into existing programs/initiatives and monitor for improvement.
The QI Program’s functions include:
- Annual Healthcare Effectiveness Data and Information Set* (HEDIS) and Consumer Assessment of Healthcare Providers and Systems* (CAHPS) data collection and analysis. Results are submitted to the National Committee for Quality Assurance* (NCQA) and are used to create a report card for consumers to compare health plans on quality.
- Coordinate the collection, analysis and reporting of data used in monitoring and evaluating care, including quality, utilization, credentialing and customer service functions system-wide to ensure that members are receiving quality care and service.
- Identify and address substandard care and issues regarding patient safety.
- Track the implementation and outcomes of quality improvement interventions.
- Evaluate the effectiveness of improving care and services.
- Conduct ongoing monitoring of care and services provided by physicians and other providers between their re-credentialing cycles.
Prevea360 Health Plan has consistently met the goals of the QI Program and remains committed to these goals, which help us maintain NCQA accreditation.
We have created programs and services that focus on high-quality care for you and your family. Here are a few examples:
Prevea360 Health Plan offers case management to members who can interact with and assist Prevea Health Plan members who have been diagnosis with a chronic health condition or have a complex health care need. These services are available to ensure member’s needs are met and their questions and concerns are addressed. To learn more about care coordination, visit our Care Management page.
Prevea360 Health Plan offers the Quit For Life® Program for members age 18 and older. This program helps participants overcome physical, psychological and behavioral addictions to tobacco using a seamlessly integrated mix of medication support and phone-based coaching. Enrollment in the Quit For Life® Program is easy — call 866-QUIT4LIFE.
*HEDIS is a set of standardized performance measures. CAHPS is a standardized survey that asks consumers and patients to report on and evaluate their experiences with health care. Prevea360 Health Plan reports its HEDIS and CAHPS scores on an annual basis to NCQA, which uses this information when accrediting health plans.