Health Plus’s Quality Improvement (QI) program is designed to continually monitor, evaluate, and improve the quality and accessibility of the health care received by our members. QI works to:
- Maintain appropriate clinical practice and preventive health guidelines
- Monitor provider compliance with established Health Plus standards
- Track adverse events and assure their timely resolution
- Establish effective systems for credentialing and re-credentialing of all participating providers and health delivery organizations
- Comply with the QI activities and reporting requirements of federal, state, and local regulatory agencies (see below)
Quality Assurance Reporting Requirements (QARR)
Every year, Health Plus and all other managed care plans in New York must submit performance data to the New York State Department of Health's Office of Managed Care. These data are collectively known as the Quality Assurance Reporting Requirements (QARR)-a series of measures that evaluate plan performance in a variety of areas, such as the effectiveness of care, access/availability of care, and satisfaction with the experience of care. QARR measures are adopted from the HEDIS (Health Plan Employer Data and Information Set) reporting requirements, administered by the National Committee for Quality Assurance (NCQA). QARR data also contain additional measures addressing public health issues of particular importance to New York State.
Health Plus's QI team uses the QARR data to select the plan's performance improvement goals for the following year. Some of these goals include:
- Increasing annual dental visits by Health Plus members
- Strengthening Project Immunize, Health Plus's initiative to increase the percentage of members completely immunized by age 2
- Initiating a lead screening data exchange with the NYC Health Department in order to track members who have not been screened for lead poisoning
- Continuing medical record reviews of all diabetic members to monitor quality of care and reduce diabetes-associated complications and hospitalizations
- Use of new software for tracking provider performance and member utilization patterns
- Continued monitoring and improvement of our prenatal, asthma disease management and HIV case management programs
What is Health Plus?
