Performance Results

Health Plan of San Joaquin (HPSJ) 2013-2014 Quality Improvement Program Executive Summary Performance Results

HPSJ’s mission is to “Continuously improve the health of our community”. In line with this mission, HPSJ’s Quality Management and Improvement (QMI) Program goals are to:

  • Improve the quality and efficiency of health care provided to our patients
  • Improve members’ experiences 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
  • Ensure 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 illness
  • Promote processes to ensure the availability of “safe, timely, effective, efficient, equitable, patient centered care” and provide oversight within the network

Quality Strategies:

HPSJ adopted the following quality strategies to achieve its goals and fulfill the mission:

  • Focus on preventive health for the members by ensuring that they get access to preventive services in a timely manner and by adopting evidence-based medicine in prevention and health promotion
  • Focus on managing chronic conditions by adhering to and providing best practices in the care of their condition(s)
  • Focus on improving patient safety by ensuring that evidenced-based clinical practice guidelines are followed in providing care and best practices are implemented at inpatient care settings.

Progress toward QI Goals in 2013 – 2014

HPSJ’s quality program improves the quality of care and services provided to its members. During the 2013-2014 measurement year, the program focused on improving performance of different quality measures during the measurement year including, but not limited to: Healthcare Effectiveness Data and Information Set (HEDIS); Consumer Assessment of Healthcare Providers and Systems CAHPS; grievance and appeals; and access and availability.

HEDIS

The Healthcare Effectiveness Data and Information Set (commonly referred to as HEDIS) is the gold standard in healthcare performance measurement. In 2013-2014, efforts to improve HEDIS scores supported HPSJ’s goal to demonstrate clinical quality improvement and preventive health activities that result in improved health status of members. HPSJ performed above the 25th percentile (minimum performance level) on a number of measures that included, but are not limited to, the following:

San Joaquin County:

  • Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
  • Immunization for adolescents
  • Comprehensive diabetes care – Nephropathy Care
  • Prenatal and Postpartum care
  • Controlling high blood pressure
  • Well Child visits (3-6 years of age)

Stanislaus County:

  • Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents
  • Comprehensive diabetes care – A1c Testing and Nephropathy Care
  • Well Child visits (3-6 years of age)
  • Breast Cancer Screening

Opportunities for Improvement:

As described in the mission statement, HPSJ is committed to continuous quality improvement and has identified an improvement opportunities for San Joaquin and Stanislaus counties. In 2014 – 2015, HPSJ will focus on the following measures:

  • Cervical cancer screening
  • Comprehensive diabetes care – A1c Testing and Retinal Eye Exam
  • Childhood Immunization Status
  • Prenatal and Postpartum care
  • Avoidance of Inappropriate Antibiotic Treatment in Adults

Ongoing Improvement Activities:

HPSJ has continued to improve its data collection methodologies, processes, and procedures from large groups and clinics. Additionally the Plan has also developed a clinical initiatives campaign that focuses on member’s individual needs and has developed reports that identify gaps in care. The outreach team has also developed a number of initiatives that include member mailings, incentives and engagement programs to reduce gaps in care.

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 2014-2015 measurement year. These include, but are not limited to, the following:

  • Rating of personal doctor
  • Rating of health care quality

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.

Other Key Achievements in 2013 – 2014

  • HPSJ successfully implemented a $500,000.00 grant from the Community Clinics Initiative. This was known as the “Health Home Innovation” project and was created to promote bi-directional integration of behavioral health care with primary care services in the treatment of diabetes and depression disorders.
  • HPSJ’s grievance rate was below 5 per 1000 members for both San Joaquin and Stanislaus counties.
  • HPSJ enhanced the complex case management and disease management programs to provide better quality and coordination of care to members.
  • HPSJ continues to exceed the provider availability standards for primary care providers and most of the high volume specialties.
  • Complaints related to access to care continue to be below 5 per 1000 members for San Joaquin and Stanislaus counties

Conclusion:
HPSJ has seen significant growth and expansion during 2014 and has taken a number of steps to ensure that it continues to provide high quality of care to its patients. The Plan is implementing its processes and procedures compliant with NCQA standards towards achieving accreditation. NCQA accreditation ensures a focus on continuously improving the health of the communities HPSJ serves.

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Posted on July 16th, 2015 and last modified on July 31st, 2015.