Our Quality Improvement (QI) program strives to ensure that our members have access to high-quality health care services that are safe, effective and responsive to their needs. Our QI program extends to all departments, at all levels. QI activities are organized around three areas: member and provider services, clinical programs and internal operations.
Through authority given by the board of directors, the Chief Medical Officer guides the direction and implementation of QI and oversees the activities of QI committees, subcommittees and work groups. The Department of Evaluation and Improvement (DEI) has the lead responsibility for plan-wide QI and works with all departments to drive QI through data analysis and effective QI tools. Neighborhood delegates behavioral health QI activities to Beacon Health Strategies and approves Beacon’s annual QI Program Description and reviews Beacon’s QI Annual Evaluation.
Within our quality structure, related functional areas work toward our overall goal of ensuring members have access to and satisfaction with health services and delivery. The objectives in support of this goal are to:
- Assure access to high quality medical and behavioral health care services
- Apply the chronic care model to all disease management programs
- Support members with acute and long-term health care needs
- Monitor and improve coordination of care in all health care settings
- Improve member and provider experience
- Monitor quality of care in nursing facilities through MDS data and other data sources
- Develop and disseminate materials and communications to engage members in their own care
- Improve HEDIS® and CAHPS® results
- Maintain grievance and appeal procedures and mechanisms and assure that members can achieve resolution to problems or perceived problems relating to access and other quality issues
- Maintain collaborative relationships with network providers and state agencies
- Improve operational efficiency across the organization
- Ensure Neighborhood’s quality improvement structure and processes adhere to NCQA standards and state and the federal requirements
- Assess the QI Program annually and make changes as necessary to improve program effectiveness
The QI program evaluation and description are presented annually to the Clinical Affairs Committee for review and to the board of directors for final approval.
For questions about or input to QI program, refer to www.nhpri.org or call Cesarina Elias at 1-401-459-6087.