Quality is a Cornerstone
Date: 12/20/16
Our Quality Improvement (QI) Program has two primary goals:
- To ensure the quality and safety of clinical care and services
- To ensure compliance with any relevant state and federal regulations standards
Toward this end, we’ve developed an extensive and comprehensive system to monitor compliance, member and provider experience, complaints, continuity and coordination of care, medical record documentation, as well as effectiveness of our case management and disease management services.
We define quality of care as care that is accessible, efficient and culturally sensitive and provided in the most appropriate setting. Wherever possible, delivery of care occurs within the member’s community and is provided according to professionally accepted standards in a coordinated, continuous manner.
Our QI strategy is developed with the help of practitioners and members. If you are interested in contributing to our QI efforts or have questions about our QI program, call 1-877-658-0305.
Examples of efforts underway to support our QI goals include:
- California Health and Wellness Quality Improvement Committee meets quarterly to evaluate progress towards QI goals
- California Health and Wellness conducts facility site reviews and medical record reviews for primary care practitioners
Why does HEDIS matter?
Through HEDIS, NCQA holds California Health & Wellness accountable for the timeliness and quality of healthcare services (acute, preventive, mental health, etc.) delivered to its diverse membership. California Health & Wellness also reviews HEDIS rates regularly as part of its quality improvement efforts.
Please consider the HEDIS topics covered in this issue of our provider newsletter:
- Women’s health screenings
- Flu
Women’s health screenings
Chlamydia screenings have remained relatively steady in the last few year—and that’s a good thing since 75 percent of chlamydia screenings in women are asymptomatic.
However, there is still room for progress. The Partnership for Prevention program estimates if screening rates could reach 90 percent (up from the current rate which lingers between 50 and 60 percent), thousands of cases of pelvic inflammatory disease could be prevented every year.
The HEDIS measure definition: The percentage of women 16–24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year.
Breast cancer screenings remain a critical way to improve survival rates. According to the American Cancer Society, among women with regional disease, the 5-year relative survival is 95% for tumors less than or equal to 2.0 cm, 83% for tumors 2.1-5.0 cm, and 65% for tumors greater than 5.0 cm.
The HEDIS measure definition: The percentage of women 50–74 years of age who had at least one mammogram to screen for breast cancer in the past two years.
Cervical cancer is preventable, with effective screening. Yet, according to the National Cancer Institute, only 46 percent of cervical cancers are diagnosed when the cancer is localized and highly treatable. Each year cervical cancer results in 4,000 deaths in the United States. Cervical Cancer screening is tied to California Health and Wellness’ Quality Provider Incentive program.
The HEDIS measure definition: The percentage of women 21–64 years of age who were screened for cervical cancer using either of the following criteria:
- Women age 21–64 who had cervical cytology performed every 3 years.
- Women age 30–64 who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years
The flu vaccine is the best protection against flu and flu-related complications. Vaccinations can reduce flu-related hospitalizations by 71 percent, according to U.S. Department of Health & Human Services.
The HEDIS measure definition:
Flu Vaccinations for Adults Ages 18–64. The percentage Medicaid adults 18–64 years of age who report receiving an influenza vaccination.