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Continuous Quality Improvement
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The goal of PHPSM's Quality Improvement Program is to continuously improve the level of care and service provided to you, our members, toward the improvement of your health status. We pursue this goal by measuring the outcomes of care and service, analyzing barriers to care and service, developing and implementing interventions and evaluating the effectiveness of these interventions. PHPSM's Quality Improvement (QI) Program monitors the quality and safety of acute, chronic and preventive clinical care and services provided in physician offices as well as in hospitals and outpatient settings. Annually, PHPSM reviews the degree to which the needs and expectations of members, practitioners, providers, and purchasers (agents and employers) are being met.
PHPSM's QI Program focuses on evaluating, planning, acting on, and providing structure processes and resources to improve the quality of care and service our members receive.
If you have any questions about our QI Program, please contact Deborah Hall-Turner, RN, Director of Care Coordination and Quality Improvement at 517.782.7154.
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The CAHPS Results Are In!
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Between February and May of every year many of you are asked about your experience with Physicians Health Plan of South Michigan. The results are reported by the NCQA Consumer Assessment of Health Plans Study (CAHPS). CAHPS collects and reports your ratings of the quality of care and services.
CAHPS results are used by consumers to make informed choices among health plans, by health care purchasers - such as employers - to select plans to offer their employees or beneficiaries, and by plans for quality monitoring and improvement.
CAHPS reports satisfaction in areas such as:
- Your overall rating of the Health Plan
- How quickly you received care
- How well doctors communicated with you
- How courteous and helpful your physician's office staff were
- How your claims were processed
- The customer service provided to you
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HEDIS Performance Measurements
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Health Plan Employer Data Information Set (HEDIS) is a comprehensive annual report outlining PHPSM's performance measurements such as adolescent immunizations, cholesterol management after an acute cardiovascular event and screening service for members with diabetes.
Why is this report important to me?
It tells you how well PHPSM is doing in specific measures compared to other health plans.
Why is the report important to PHPSM?
PHPSM's Quality Improvement Program works to continuously improve the level of care and service provided to you toward the improvement of your health status. One way this goal is measured is through our annual (HEDIS) report.
What were the results?
The HEDIS results continue to show positive performance in nearly all effectiveness of care measures. Another way to determine "what is this report telling me?" is to think of it as reporting the percent of members who have participated in the specific measure.
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NCQA
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For an organization to become accredited by NCQA, it must undergo a rigorous survey and meet certain standards designed to evaluate a health plan's clinical and administrative systems. In particular, NCQA evaluates health plans in the areas of patient safety, confidentiality, consumer protection, access, service, and continuous improvement.
In 2005, Physicians Health Plan of South Michigan underwent its first NCQA survey. This initial survey resulted in a huge success for PHPSM as we achieved EXCELLENT accreditation, which is the highest accreditation available from NCQA. The NCQA accreditation stands for three years. Our next survey will be conducted in 2008.
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eValue8
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eValue8 is a leading evidence-based request for information tool widely used by business health coalitions, their purchasers, members, and employers to assess and manage the quality of health care vendors. PHPSM's performance was compared to other health plans within the state of Michigan who participated in responding to the eValue8 RFI, as well as other health plans nationally. PHPSM will continue to participate in this resource for purchaser, members, and employers.
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PHPSM Implements a Survey Tool
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With the help of a standard telephone, PHPSM is creating and recording their own surveys and/or interviews for members. These surveys gather numeric or spoken information. Members can dial in 24 hours a day, 365 days a year. Results of the call are instantly stored in a standard database, ready for analysis or automated reporting. PHPSM can immediately address their members' issues.
PHPSM will ask members to participate in various surveys such as Customer Service, Disease Management (Asthma, Depression, Diabetes) and New Member Satisfaction. These surveys are intended to gather information so that PHPSM can immediately take action to continue to improve our service to you.
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Quality Partnerships
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Because quality is so important to us here at PHPSM, we are proud to be owned by Foote Health System. Foote's demonstrated committment to quality has led to their recognition locally, regionally and nationally for their successes in delivering quality care. Click here to view more on Foote Health System's committment to quality.
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Leapfrog
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Leapfrog is a program to provide information about health care safety, quality and customer value. This is done by asking hospitals to voluntarily report on the steps they take to improve patient care in a survey. Significant scientific evidence shows that the four quality and safety practice areas questioned in the survey reduce unnecessary deaths and injuries.
The link Leapfrog Group for consumers will take you to the ratings of hospital quality. While not all specific procedures, surgeries or conditions are treated at every hospital, take a moment to see how your favorite facility has implemented processes and/or procedures to reduce preventable medical mistakes. For more information on Leapfrog, please contact Ann Fitton, RN, Quality Improvement Specialist, at 517-782-7154.
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Quality Standards
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PHPSM wants to provide the best care for you and your family. We encourage our network of physicians, facilities and vendors to provide the highest quality of care offered. We monitor programs and services to be sure that our members are receiving the "best practice" when compared to nationally accepted best practice guidelines. When you have had an unfortunate experience with a provider in our network, we would like to know so that we can help improve the quality of care given to our members.
Four Categories for Quality Standards
- Quality of Care - member dissatisfaction with the management of their medical issues by one of our network providers.
- Quality of Service - non-medical issues in which the provider or office staff have not met the expectations of our members.
- Administrative - member dissatisfaction with PHPSM's processes and/or service received from Plan staff.
- Pharmacy - issues with the local pharmacy or mail service, such as with the staff, medications, or dispensing of drugs.
PHPSM strives to promote the highest quality standards of care and service throughout our network for the protection of member's rights and safety. If you have questions or concerns about the complaint resolution process at PHPSM, please call Customer Service at 517.787.6865 or 1.800.394.7569.
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