Quality Improvement Program

DHMP’s Quality Improvement Program is designed to support the mission of DHMP by promoting the delivery of high quality accessible healthcare services that will enhance or improve the health status of DHMP members.

The Quality Improvement Program provides a formal process to objectively and systematically monitor and evaluate quality and safety of clinical care and service utilizing a multidimensional approach measured through different performance dimensions. These dimensions include appropriateness, efficiency, effectiveness, availability, timeliness and continuity. This approach enables DHMP to focus on opportunities for improving operational processes, member and provider satisfaction as well as health outcomes.

The quality DHMP seeks to achieve through implementation of the Quality Improvement Program, is to deliver the “right care or service, at the right time, by the right staff” in the most appropriate place and to continuously improve the care, safety and service provided to our members.

The quality improvement process is based on a continuous improvement cycle of measurement, assessment, planning, implementation and evaluation. Data is systematically collected prospectively, concurrently and/or retrospectively on clinical, safety, preventative and service performance. Data is analyzed, summarized and presented as information with recommendations to the Quality Management Committee. Quality Improvement works collaboratively with various DHMP departments to develop and implement initiatives targeted at improving clinical care, outcomes, safety and service.

QI Activities Summary

In 2016 QI activities focused on diabetes, prenatal/postpartum care, behavioral health,  member satisfaction and preventive health measures for both children and adults. QI team members collaborated with Amublatory Care (ACS) through various work groups in diabetes, weight management, children’s preventive health, and preventive cancer screening. We worked with school-based health centers in the Denver Health system to improve the delivery of well-child care to our commercial members enrolled in Denver Public Schools. Additionally, QI continues to make improvements in obtaining real time data from the warehouse and registries, which is helpful in the many interventions conducted throughout the year.

2016 Work Plans

QI Department develops a Work Plan annually. The Work Plan covers the scope of the QI Program and includes:

  • Written measurable yearly objectives for the quality and safety of clinical care and quality of service activities scheduled, including all QI collaborative activities with departments such as, but not limited to: Behavioral Health and Wellness, Utilization Management, Complex Case Management.
  • Yearly objectives and planned activities, time frames for achieving, and those responsible
  • Monitoring of previously identified issues

2017 Commercial  & Medicare Work Plan

2016-2017 CHP+ Work Plan

Clinical Practice Guidelines

Denver Health Medical Plan (DMHP) adopts and disseminates clinical practice guidelines to assist providers and members in making decisions about appropriate health care for specific clinical conditions. Our clinical practice guidelines produce care recommendations to support the provision of high-quality, evidence-based care, based on existing clinical guidelines and recognized scientific evidence. We utilize and reference expert professional and clinical sources to ensure our guidelines reflect the highest level of evidence based content. Clinical practice guidelines are also used to guide efforts to improve the quality of care for our members and facilitate implementation of evidence-based clinical recommendations into practice.

Preventive Guidelines:

Clinical Guidelines:

Quality Improvement Program Descriptions:

Annual Evaluations:

Commercial Access to Care Standards
Emergency Care Timeframe Timeframe Goal
Emergency Care 24 hours a day, 7 days a week Met 100% of the time
Emergency Care-Behavioral Health Non-life Threatening Within 6 hours Met 100% of the time
Urgent Care-Medical and Behavioral Health Within 24 hours Met 100% of the time
Primary Care-Routine Symptoms Non-urgent Within 7 calendar days Met > or = to 90% of the time
Primary Care-Access to After-hours Care Office number answered 24 hrs. /day, 7 days a week by answering service or instructions on how to reach a physician Met > or = to 90% of the time
Specialty Care-Non-Urgent Within 60 calendar days Met > or = to 90% of the time
Routine Behavioral Health Care Within 10 business days Met > or = to 90% of the time
Preventive Visits / Well Visits Within 30 calendar days Met > or = to 90% of the time

Quality Improvement Annual Summary Reports

HEDIS is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. Altogether, HEDIS consists of 92 measures across 5 domains of care. Because so many plans collect HEDIS data, and because the measures are so specifically defined, HEDIS makes it possible to compare the performance of health plans on an "apples-to-apples" basis. Health plans also use HEDIS results themselves to see where they need to focus their improvement efforts.

HEDIS measures address a broad range of important health issues. Among them are the following:

  • Asthma Medication Use
  • Persistence of Beta-Blocker Treatment after a Heart Attack
  • Controlling High Blood Pressure
  • Comprehensive Diabetes Care
  • Breast Cancer Screening
  • Anti-depressant Medication Management
  • Childhood and Adolescent Immunization Status
  • Childhood and Adult Weight/BMI Assessment

CAHPS

The CAHPS Health Plan Survey is a tool for collecting standardized information on enrollees' experiences with health plans and their services. Since its launch in 1997, this survey has become the national standard for measuring and reporting on the experiences of consumers with their health plans. A version of this survey is conducted in almost every State in the U.S.

CAHPS measures health care consumers' satisfaction with the quality of care and customer service provided by their health plan. Denver Health Medical Plan chose the mixed mail/telephone protocol. This protocol included mailing a questionnaire with a cover letter, followed by a thank you/reminder postcard. For those selected members who did not respond to the first questionnaire, a second questionnaire with a cover letter encouraging participation was sent which was also followed by a reminder postcard. If a selected member still did not respond to the questionnaire, at least four telephone calls were made to complete the survey using trained telephone interviewers. NCQA originally designed this protocol with the goal of achieving a total response rate of at least fifty-five percent (55%).

2016 Interventions

DHMP Open Shopper activity will continue in 2016-2017 to evaluate the appointment making process within the ACS clinics, pharmacy, and the Specialty Appointment clinics. The scope of Open Shopper has expanded to include our extended network facilities. To improve member satisfaction the QI staff has employed strategies to increase CAHPS and HEDIS scores when there is appropriate correlations. To improve CAHPS member satisfaction and HEDIS measure rates for annual well visits for adults and children, some clinics will be holding clinical hours on Saturdays. Provider education training on CAHPS and HEDIS will be developed around gaps in knowledge.

HEDIS Measure HEDIS 2014 HEDIS 2015 HEDIS 2016 GOAL
Commercial HEDIS Rates for Denver Health Medical Plan, Inc.
Well-child Visits in the First 15 Months of Life (W15) 82.64% 78.15% 73.55% 76%
Well-child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34) 77.37% 80.52% 74.17% 77%
Adolescent Well-Care Visits (AWC) 44.69% 43.07% 41.13% 43%
Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – BMI 81.51% 81.51% 71.53% 74%
Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – Nutrition 75.18% 75.18% 71.53% 74%
Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – Physical Activity 60.34% 60.34% 57.66% 60%
HEDIS Measure HEDIS 2014 *HEDIS 2015 HEDIS 2016 GOAL
CHP+ HEDIS Rates for Denver Health Medical Plan, Inc.
Well-child Visits in the First 15 Months of Life (W15) 62.22% 4% 46% 49%
Well-child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34) 67.15% 48.52% 61.17% 63%
Adolescent Well-Care Visits (AWC) 48.91% 34.84% 48.42% 50%
Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – BMI 93.67% 90.27% 77.86% 82%
Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – Nutrition 79.32% 78.59% 78.59% 81%
Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – Physical Activity 66.67% 62.77% 65.21% 67%

* The asteric represents Administration data only for the year 2015.

HEDIS Measure HEDIS 2014 HEDIS 2015 HEDIS 2016 GOAL

Medicare HEDIS Rates for Denver Health Medical Plan, Inc.

Breast Cancer Screening 76.80% 73.70% 65.81% 67%
Controlling High Blood Pressure 70.07% 78.59% 62.53% 65%
Adult BMI Assessment 93.92% 92.70% 97.08% 98%
Comprehensive Diabetes Care: Eye Exam (Retinal) Performed 62.53% 64.48% 41.39% 44%
Colorectal Cancer Screening 62.04% 66.42% 87.83% 89%
Intervention Description of Activities
Improving Well-Child Visits
Healthy Hero Birthday Postcards

Children 2-19 years of age receive a birthday card informing them to come for their annual visit. These mailings have been going out to members since January 2009.

QI team amended the Healthy Heroes Birthday cards in 2014 to include a checklist of developmental topics the provider will cover in the well-child visit as a way of engaging the member to participate in care.

School-Based Health Centers (SBHC) Gift Card Incentive Program Students between the ages of 12-19 who are enrolled in one our School Based Health Centers (SBHC) will be eligible to recieve a $10 gift card to either Fandango, Subway or Ross for completing their annual well-child visit at a SBHC at no cost to the member. Providers will work with QI to complete visits and increase the WCC and AWC HEDIS measures.
Baby’s First Year Incentive Program In 2013, the Marketing Department expanded additional benefits to include “Baby’s First Year” incentives. For each newborn visit completed in the first 15 months of life, members will receive an incentive.
Provider Education on HEDIS Documentation To improve medical record documentation for well-child visit and Weight Assessment and Counseling for Physical Activity and Nutrition (WCC) measures, the QI team provides ongoing provider education by giving presentations and creating toolkits on compliant documentation.
HEDIS Measure HEDIS 2014 HEDIS 2015 HEDIS 2016 GOAL
Commercial HEDIS Rates for Denver Health Medical Plan, Inc.
Prenatal and Postpartum Care (PPC) – Timeliness of Prenatal Care 96.89% 93.30% 95.98% 97%
Prenatal and Postpartum Care (PPC) – Postpartum Care 83.23% 84.36% 81.41% 84%
Invervention Description of Activities
Improving Perinatal Care
Prenatal Incentive Program Each month, all pregnant members receive a mailing informing them of the Denver Health Medical Plan Prenatal Incentive Program. For each prenatal visit completed at Denver Health in the program timeframes, members receive different incentives ranging from a spa kits to a new car seat.
Postpartum Incentive Program All members receive a mailing after delivery informing them of the Mom and Baby incentive program. Members who deliver at Denver Health and attend a postpartum visit receive an incentive.
Postpartum Outreach Calls Our Care Support team calls all members 3-5 days after delivery to schedule postpartum visits within the 3 to 8 week timeframe and follows up with members to ensure visit completion. The team also offers assistance with referrals and medication if needed.
Invervention Description of Activities
Improving Adult Screening Visits
Breast Cancer Screening All women 50-69 years old, who are in need of a mammogram, are sent a mailer reminding them to schedule an appointment. Members have the option to either get their mammogram from the radiology clinic on the main Denver Health campus or utilize the Denver Health Women’s Mobile Clinic.
Diabetic Eye Exams All diabetic members who are in need of a diabetic eye exam are targeted for outreach to schedule an appointment. Medicare members have the option to utilize Denver Health’s eye clinic or One Hour optical for exams.

For more information on incentive programs, please call member services at 303-602-2100.

NCQA Accreditation

Denver Health Medical Plan, Inc. has earned Accreditation from the National Committee for Quality Assurance (NCQA). The accredited rating is awarded to organizations with programs for service and clinical quality that meet basic requirements for consumer protection and quality improvement.

NCQA is a private, non-profit organization dedicated to improving health care quality.

NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA is committed to providing health care quality information for consumers, purchasers, health care providers and researchers.