Quality Assurance and Performance Improvement

The Denver Health Medical Plan (DHMP) Quality Improvement Program is designed to support the mission of DHMP by promoting the delivery of high quality, cost effective and accessible health care services that enhance or improve the health and wellbeing of our members.

The Quality Improvement Program:

  • Oversees the Quality Assurance and Performance Improvement (QAPI) Plan for DHMP, including applicable regulatory requirements, committee governance structures, continuous performance improvement initiatives, and NCQA health plan measures. This work is focused on improving access to care, quality, and health outcomes for members that we serve.
  • Monitors performance improvement activities across all DHMP health plans, including efforts to strengthen continuity and coordination of care. Provides a structured framework for the continuous quality improvement cycle by identifying, prioritizing, and addressing opportunities related to care coordination, social risk factors affecting health, and member experience. This includes ongoing collaboration with network providers and internal DHMP departments to support effective service delivery and improved health outcomes.

Clinical Practice and Preventive Care Guidelines

Clinical care guidelines are intended to assist care providers in the provision of patient care and are not a substitute for independent medical decision-making.

Asthma Care
Diabetes Management for Non-Pregnant Adults in the Outpatient Setting
Medicaid Behavioral Health Care
Antenatal and Postpartum Care
Pediatric and Adolescent Preventive Health Care
Pediatrics Early Intervention, Child Find or Developmental Delay Clinical Referral

References

Recommendations for Preventive Pediatric Health Care | Periodicity Schedule
Bright Futures | Promoting Health for Children & Youth with Special Health Care Needs

Quality Assurance Performance Improvement

Program Descriptions

  • Describe the QI Program and associated activities
  • Outline various committee structures

Medicaid and CHP+ Program Description

Medicare and Exchange/CO Option Program Description

Evaluations

  • Provide detail of the quality activities, which are are data-driven using prior-year QI analyses to guide interventions and decisions, with a focus on health outcomes
  • Detail how we performed in different measures (cancer screenings, member satisfaction, care management, etc.)

Medicaid and CHP+ Impact Analysis

Medicare and Exchange/CO Option Program Evaluation

Work Plans

  • Are developed for the upcoming year using prior year quality activity data
  • Outline the work and goals of various departments across the organization for the coming year

Work Plans

HEDIS Scores and CAHPS Health Plan Survey

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Photo of health care provider talking with patient
HEDIS

HEDIS is a tool used by more than 90% of U.S. health plans to measure performance on important dimensions of care and service. 

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Photo of a woman filling out a survey.
CAHPS

The CAHPS Survey is a tool for collecting standardized information on members' experiences with their health plan and services.

Member Resources

QI Practitioner/Provider Support

DHMP aids network practitioners/providers in achieving shared objectives of improving quality and addressing population health concerns through quality-related data sharing, offering evidence-based tools for shared decision-making (SDM), and providing support for transforming practices among primary care practitioners. This support includes facilitating the transition toward more integrated or advanced practices and adopting value-based care delivery methods. If your practice is interested in transforming to a Patient-Centered Medical Home (PCMH), be sure to check out our Patient Centered Medical Home Transformation Best Practices tip sheet. Additionally, DHMP offers cultural competency training for network practitioners and staff. 

 

 

NCQAaccredited

The National Committee for Quality Assurance (NCQA) is non-profit organization widely considered to be the gold standard for health plan accreditation, and DHMP is committed to continuously improving the quality, accessibility, and overall member experience of the communities we serve.