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 2019, QI activities will focus on diabetes, prenatal/postpartum care, behavioral health, member satisfaction and preventive health measures for both children and adults. QI team members will collaborate with Ambulatory Care (ACS) through various work groups in diabetes, weight management, children’s preventive health, and preventive cancer screening. We will work 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 will continue to make improvements in obtaining real time data from the warehouse and registries, which is helpful in the many interventions conducted throughout the year.
Quality Improvement Work Plans
The 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: Health Management, Utilization Management, Complex Case Management.
- Yearly objectives and planned activities, time frames for achieving, and those responsible
- Monitoring of previously identified issues
Commercial, Medicare and Elevate Work Plan
Medicaid/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:
Quality Improvement Program Descriptions:
| 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 7 calendar 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 includes more than 90 measures across 6 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 utilizes the mixed mail/telephone protocol. This protocol includes 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 is sent which is also followed by a reminder postcard. If a selected member still does not respond to the questionnaire, at least four telephone calls are 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%).
Interventions
DHMP Open Shopper activity will continue in 2019 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 2016 | HEDIS 2017 | HEDIS 2018 | GOAL |
|---|---|---|---|---|
| Well-child Visits in the First 15 Months of Life (W15) | 73.55% | 81.15% | BR* | 84% |
| Well-child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34) | 74.17% | 77.99% | 83.54% | 86% |
| Adolescent Well-Care Visits (AWC) | 41.13% | 43.21% | 48.60% | 51% |
| Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – BMI | 71.53% | 91.24% | 88.08% | 91% |
| Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – Nutrition | 71.53% | 80.05% | 79.81% | 82% |
| Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – Physical Activity | 57.66% | 63.50% | 68.61% | 71% |
* BR= Biased Rate- removed for biased results
| HEDIS Measure | *HEDIS 2016 | *HEDIS 2017 | *HEDIS 2018 | GOAL |
|---|---|---|---|---|
| Well-child Visits in the First 15 Months of Life (W15) | 46.00% | 6.78% | N/A | 9% |
| Well-child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34) | 61.17% | 59.48% | 46.64% | 49% |
| Adolescent Well-Care Visits (AWC) | 48.42% | 41.37% | 37.64% | 40% |
| Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – BMI | 77.86% | 7.94% | 17.71% | 20% |
| Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – Nutrition | 78.59% | 1.46% | 6.41% | 9% |
| Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – Physical Activity | 65.21% | 0.80% | 1.40% | 4% |
* The asterisk represents Administrative data only.
| HEDIS Measure | HEDIS 2016 | HEDIS 2017 | HEDIS 2018 | GOAL |
|---|---|---|---|---|
| Breast Cancer Screening | 70.83% | 71.25% | 71.80% | 74% |
| Controlling High Blood Pressure | 69.34% | 74.94% | 73.24% | 76% |
| Adult BMI Assessment | 96.11% | 98.05% | 98.30% | 99% |
| Comprehensive Diabetes Care: Eye Exam (Retinal) Performed | 67.88% | 67.88% | 76.89% | 79% |
| Colorectal Cancer Screening | 67.40% | 60.58% | 62.77% | 65% |
| Intervention | Description of Activities |
|---|---|
| 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. |
| 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 2016 | HEDIS 2017 | HEDIS 2018 | GOAL |
|---|---|---|---|---|
| Prenatal and Postpartum Care (PPC) – Timeliness of Prenatal Care | 95.98% | 96.28% | 96.22% | 99% |
| Prenatal and Postpartum Care (PPC) – Postpartum Care | 81.41% | 80.17% | 84.03% | 87% |
| Invervention | Description of Activities |
|---|---|
| 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 Health Plan 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.