Quality improvement program
Standards, measurement and programs
The Dean Health Plan Quality Improvement (QI) Program provides standards to measure and assess the quality of clinical care and the quality of services our members receive. Our program was developed to help achieve these 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 include primary and specialty care practitioners.
- Identify opportunities to improve 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 preventive care, clinical practice guidelines, complex case programs, disease management programs, pharmacy initiatives, care coordination 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:
- Collecting and analyzing data from the annual Healthcare Effectiveness Data and Information Set* (HEDIS) and Consumer Assessment of Healthcare Providers and Systems* (CAHPS). 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.
- Coordinating 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 members are receiving quality care and service.
- Identifying and addressing substandard care.
- Identifying and addressing issues regarding patient safety.
- Tracking the implementation and outcomes of quality improvement interventions.
- Evaluating the effectiveness of improving care and services.
- Conducting ongoing monitoring of care and services provided by physicians and other providers between their re-credentialing cycles.
We consistently meet the goals of the QI Program and remain committed to these goals, which help us maintain NCQA accreditation.
Quality care programs at Dean Health Plan
We have created programs and services that focus on high-quality care for you and your family, including care coordination, pregnancy care and tobacco cessation. See more in the slide show below.
*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.