Our Quality Improvement (QI) program is an organization-wide program that strives to ensure that our members have access to high-quality health care services that are safe, effective and responsive to their needs. 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 has the lead responsibility for organization-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 evaluation and description. 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:
- Ensure that quality medical and behavioral health care is available and accessible
- Deliver intervention programs aimed at improving preventive care rates
- Apply the chronic care model to all disease management programs and comorbid conditions
- Provide support to members with acute health care needs
- Ensure member and provider satisfaction
- Monitor and improve coordination of care in all health care settings and ensure member safety
- Monitor physician adherence to clinical practice guidelines
- Develop and disseminate materials and communications to engage members in their own care
- Improve HEDIS® and CAHPS® results
- Maintain collaborative relationships with network providers
- Ensure ongoing operational efficiency across the organization
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.
Questions about QI? Refer to www.nhpri.org or call Cesarina Elias at 1-401-459-6087.