EmblemHealth's Quality Improvement Program establishes the framework and processes that facilitate continuous improvement of medical and behavioral health care and services provided to EmblemHealth, GHI and HIP plan members.
A key objective is to assist members in becoming more active and more knowledgeable participants in their own care, including preventive care, by implementing initiatives and health management programs that focus on education. To support initiatives and to assist our providers to improve the care and service members receive, we continue to provide tools and resources via News&Notes, (such as you are reading now), on-hold messaging, educational detailing visits and Web site updates.
In addition, we send you direct mailings. Many of these mailings ask you to address medical issues with your patients, whom we have identified from our claims and other supporting data, to ensure that we maintain best practices on behalf of our members, your patients. Please make note of these requests and take action on them.
We also monitor care and services provided and evaluate whether it meets or exceeds established regional and national standards of care, through our National Committee for Quality Assurance and URAC accreditation processes and our annual Healthcare Effectiveness Data and Information Set (HEDIS®), Consumer Assessment of Healthcare Providers and Systems (CAHPS®) and New York State Department of Health Quality Assurance Reporting Requirements (QARR) scores. The program also includes activities that promote patient safety and improve cultural competencies within our provider networks.
The 2013 Program focuses on a broad range of clinical measures some of which include:
Screenings for breast, cervical and colorectal cancer
Screening for glaucoma
Lead screening for infants
Smoking and tobacco use cessation
Controlling high blood pressure
Persistence of beta blocker treatment
after a heart attack
Medication adherence for asthma, rheumatoid arthritis and depression
Effective diabetes management
Childhood and adolescent immunization
Appropriate use of antibiotics
Monitoring EmblemHealth's quality measures resulted in HIP Commercial HMO being rated the top performing plan in New York City and Long Island for QARR 2011, and a rating for HIP Medicaid as the top-performing plan in New York City, Long Island and the Hudson Valley region. This is detailed in the New York State 2012 Regional Consumers Guides. In addition, HIP Medicaid earned the highest level of recognition from the State of New York 2012 Quality Incentive for Medicaid Program for the success of our quality oversight.