Quality Improvement Program, Quality - Dean Health Plan

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Quality Improvement Program

The Dean 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 Dean 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.
  • Identify and address 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.

Dean 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 just a few examples:

Care Coordination. Onsite case management for members who receive primary care at Dean Clinic - West and Dean Clinic – East.

  • This program offers the benefit of having a Dean Health Plan nurse case manager and social worker inside the clinic who can interact with members and assist with complex health issues.
  • Being onsite allows case managers to easily collaborate with multiple providers to coordinate services and resources for patients across the continuum of their health care.
  • This program has resulted in increased member and provider satisfaction. To learn more about care coordination, visit deancare.com/caremanagement.

Pregnancy Care. Strong Beginnings is a free and optional program for Dean Health Plan members, designed to promote healthy moms and babies by providing telephonic outreach services and educational mailings to women who are pregnant, who have recently delivered or who are thinking about becoming pregnant.

  • Dean Health Plan staff help women find a provider, find education classes and provide information about other services available.
  • A registered nurse is available to provide obstetric (OB) case management services for women experiencing high-risk pregnancies and as a resource for questions about pregnancy, labor and delivery, breastfeeding, making healthy changes like quitting smoking and many other health topics.
  • In the past two years over 2,200 members have enrolled in our Strong Beginnings program. In addition, 80 percent of members who responded to our satisfaction survey found the prenatal welcome packet, baby care booklet and immunization card helpful.
  • To learn more about this program or to complete a self-referral online, visit deancare.com/strongbeginnings.

Tobacco Cessation. Dean 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 seam-lessly integrated mix of medication support and phone-based coaching.
  • Enrollment in the Quit For Life® Program is easy - call (866) QUIT4LIFE or visit deancare.com/quitforlife to learn more.

*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. Dean Health Plan reports its HEDIS and CAHPS scores on an annual basis to NCQA, which uses this information when accrediting health plans.

Accreditation is by the National Committee for Quality Assurance. NCQA is an independent, not-for-profit organization that evaluates health plans based on over 50 standards of care and service to determine health plan accreditation.

Dean Health Plan is a Qualified Health Plan issuer on the Health Insurance Marketplace.

 

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