Health Plan of San Joaquin 2019/2020 Quality Management Program Evaluation

Executive Summary

Health Plan of San Joaquin’s (HPSJ) mission is to “provide healthcare value and advance wellness through community partnerships.” In tandem, the vision is to “Continuously improve the health of our community.” In line with this mission and vision, HPSJ’s Quality Management (QM) Program goals are to:

  • Improve the quality and efficiency of health care provided to our patients.
  • Improve members experience with services and care received.
  • Improve patients’ health outcomes.
  • Provide culturally sensitive and linguistically appropriate services.
  • Promote the safety of all members in all treatment settings.
  • Ensures timely access and availability of services for all members, including those with complex or special needs, including physical or developmental disabilities, multiple chronic conditions and severe mental illnesses.

Promote processes to ensure the availability of “safe, timely, effective, efficient, equitable, patient centered care” and collaborate with the network providers and the community.

Scope of the QM Program

The scope of the QM Program is comprehensive and addresses both the quality and safety of medical and behavioral health care provided to our members and participants for all lines of businesses. Behavioral Health care is a benefit for the Medi-Cal members and is administered by HPSJ. Behavioral health services for members with severe functional impairment are “carved out” of the contract by the state to the County Behavioral Health System. Coordination of medical and behavioral health care is an integral part of HPSJ’s Care Management Program.

Continuous quality management and improvement is accomplished through QI teams who conduct:

  • Systematic data collection
  • Qualitative and quantitative analysis
  • Identification of improvement opportunities
  • Activity planning and implementation
  • Ongoing monitoring and evaluation

Progress towards QI Goals 2019/2020

HPSJ implemented many initiatives during HEDIS 2020/MY 2019 that have impacted rates significantly in a positive way. Unfortunately, due to the impact of COVID-19 on our community providers, the positive impact is not fully realized. HPSJ directs interventions in three focus areas: provider, member, and data. Provider initiatives take the form of incentives, alerts, newsletters, and the Provider Partnership Program. Member interventions take the form of education, outreach, and incentives. Data improvements include expanding and maintaining supplemental data sets, data analysis and pursuing additional supplemental data sources. Health Plan of San Joaquin has grouped measures under domains to focus and align its improvement efforts. The four domains include Women’s Health, Children’s Health, Acute and Chronic Disease Management

Planned Opportunities for Improvement

HPSJ has identified measures that have the biggest impact to our community and will focus HEDIS 2020 initiatives on those areas. Based on guidance received from the Department of Healthcare Services the plan’s focus with be the newly developed MCAS or the Managed Care Accountability Set. To develop an effective strategy, the plan has assigned each high priority measure into domains outlined below.

  • Women’s Healthcare
    • Breast Cancer Screening
    • Cervical Cancer Screening
    • Chlamydia Screening
    • Prenatal and Postpartum care
  • Acute and Chronic Disease Management
    • HbA1c testing
    • Controlling Diabetes
    • Diabetic Prevention
    • Adult BMI
    • Controlling Hypertension
    • Asthma Medication Ratio
    • Plan All Cause Readmission
  • Children’s Healthcare
    • Immunizations
    • Wellness visits
    • Well Child visits
  • Behavioral Healthcare Measures
    • Follow up ADHD medication initiation phase, and the acute phase
    • Antidepressant Medication Management acute, and continuation phase

CAHPS

In addition to HEDIS clinical measures, HPSJ’s QI program supported companywide efforts to improve the member’s experience with our service and our provider network. HPSJ uses Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores to evaluate member experience. HPSJ performed better than the Medi-Cal Managed Care (MCMC) average rating on the following CAHPS measures:

  • Rating of the health plan
  • Customer service
  • Getting care needed
  • Getting care quickly

Based on the survey results, HPSJ has identified opportunities to improve member satisfaction during the 2019 measurement year. These include, but are not limited to, the following:

  • After visit Surveys to identify providers in need of support.
  • Provider Education to inform providers of member experience with doctors, and care coordination.
  • Member focused newsletters to inform members on how to receive care, tests, and treatment.
  • Post Care Coordination on the Provider portal to support providers when linking services for members.
  • Profiling providers so that HPSJ may assigned based on members preference.

Ongoing Improvement Activities:

HPSJ has initiated a multidisciplinary team approach to improve member satisfaction scores. HPSJ will be working with the provider relations department to collaborate and partner with providers on methods to improve member satisfaction. The Plan will focus on customer service initiatives like first-call resolution of member issues, improving member communication, and member education and outreach. Additional initiatives are also being developed to improve claims processing and member access to care that will ultimately result in improved member satisfaction.

Conclusion

In conclusion, HPSJ’s 2019/2020 QI Annual Evaluation and Effectiveness findings inform the 2019-2020 QI Work Plan. Key issues and improvement opportunities are monitored routinely to ensure that adequate input is received and implemented on a regular basis. The goal of Health Plan of San Joaquin’s Quality Management Program is to develop methods to continually improve the quality of medical care, and service provided to its membership. Towards this goal the Quality Improvement Department will continue to work within its continuous quality

improvement model focused on member focused quality initiatives that can be most impactful. The plan will continue to analyze quality indications to ensure goals/benchmarks are being met.

Please visit www.hpsj.com/quality to download and read the entire Quality Management Evaluation or call 209-942-6300 to request a paper copy.

Downloads

Posted on July 16th, 2015 and last modified on February 24th, 2021.

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