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  • 2016 QUALITY IMPROVEMENT PROGRAM

    ANNUAL EVALUATION

  • 2

    2016 Quality Improvement (QI) Program Annual Evaluation

    ______________________________________ __________________

    Margaret Beed, M.D. Date

    Chief Medical Officer

    Health Plan of San Mateo

    _______________________________________ ___________________

    Barbara Erbacher Date

    Chairperson

    San Mateo Health Commission

  • 3

    TABLE OF CONTENTS

    Introduction..............................................................................................................................................................................5

    HPSMMembership..............................................................................................................................................................5

    HEDISResults............................................................................................................................................................................7

    CHILDHOODIMMUNIZATIONSTATUS.................................................................................................................................7

    WeightAssessmentandCounselingforNutrition&PhysicalActivityforChildrenandAdolescentsBMI.........................8

    CervicalCancerScreening....................................................................................................................................................8

    PrenatalCare........................................................................................................................................................................9

    PostpartumCare..................................................................................................................................................................9

    ControllingHighBloodPressure(CBP)...............................................................................................................................10

    ComprehensiveDiabetesCare(CDC).................................................................................................................................11

    QualityImprovementPrograms.............................................................................................................................................11

    QualityofClinicalCareActivities........................................................................................................................................11

    PrenatalandPostpartumCareProgram........................................................................................................................11

    CervicalCancerScreeningOutreachProject..................................................................................................................16

    Reducing30DayReadmissions.....................................................................................................................................19

    ControllingHighBloodPressure....................................................................................................................................24

    ImprovingA1CTestingforCareAdvantageDSNPMembersProject...........................................................................25

    InitialHealthAssessment(IHA)......................................................................................................................................28

    SafetyofCareandQualityofServiceActivities.................................................................................................................31

    AnnualReviewofClinicalGuidelines.............................................................................................................................31

    PotentialQualityIssueMonitoring................................................................................................................................33

    FacilitySiteReviewandMedicalRecordReview...........................................................................................................33

    PhysicalAccessibilityReview(PAR)................................................................................................................................35

    NurseAdviceLine(NAL).................................................................................................................................................37

    TimelyAccesstoCare....................................................................................................................................................39

    PatientExperienceConsumerAssessmentofHealthcareProvidersandSystems(CAHPS)SurveyResults...............44

  • 4

    CULTURALandLINGUISTICS...................................................................................................................................................47

    LanguageAssistance..........................................................................................................................................................50

    AvailabilityofTranslatedMaterial.................................................................................................................................50

    AccesstoInterpreterServices.......................................................................................................................................50

    LinguisticCapabilityofPlanStaff...................................................................................................................................50

    LinguisticCapabilityofProviderNetwork......................................................................................................................51

    ProviderNetwork...........................................................................................................................................................51

    ProviderCompliancewithLanguageAssistanceProgram.............................................................................................51

    MonitoringandAdherence............................................................................................................................................51

    CLASRelatedGrievances&Appeals..............................................................................................................................52

    ConclusionandNextSteps............................................................................................................................................52

    HealthEducation....................................................................................................................................................................52

    GroupNeedsAssessment..................................................................................................................................................52

    WeightWatchers................................................................................................................................................................54

    VeggieRx.............................................................................................................................................................................54

    HealthEducationMaterials................................................................................................................................................55

    HealthEducationClasses...................................................................................................................................................56

    SmokingCessation.............................................................................................................................................................56

    HPSMwebsite....................................................................................................................................................................56

    GrievancesandAppeals..........................................................................................................................................................56

    CAREADVANTAGECalMediConnect(CareAdvantageCMC)..............................................................................................57

    CAREADVANTAGEDSNP....................................................................................................................................................59

    MEDICAL............................................................................................................................................................................60

    OTHERLINESOFBUSINESS:................................................................................................................................................62

    TimelinessofComplaintResolution...................................................................................................................................63

    Appendix:HEDIS2016Results

  • 5

    Introduction

    This program evaluation incorporates results from quality activities carried out in 2016. It should be noted that based on the HEDIS data collection and reporting schedule, HEDIS results discussed below are of services provided in 2015, which were then collected and analyzed in 2016.

    HPSM MEMBERSHIP

    The following chart summarizes the membership in HPSMs current lines of business as of December 1, 2016:

    HPSM Membership by Age:

    Membership by Gender:

    10%

    24%

    8%46%

    12%

    2016 Membership by Age

    Age 00-05

    Age 06-18

    Age 19-24

    Age 25-64

    Age 65+

    Total

    Medi-Cal CareAdvant

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