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Quality Program Suite

As individuals increasingly consider the quality and performance of healthcare payers, organizations like the National Committee for Quality Assurance and the Centers for Medicare and Medicaid Services analyze member feedback and outcomes to provide performance ratings, which can be directly tied to a payer’s financial success. Because payers are appraised through Five-Star Quality ratings, HEDIS scores and other metrics, it is essential to find cost-effective ways of improving satisfaction and supporting health and wellness.

The Program Suite

The Quality Program Suite is designed to help improve performance metrics by offering engaging, educational content that promotes preventive care and chronic care management as well as sets member expectations to improve satisfaction and health plan perception. It includes the following programs:

Five-Star Quality Domains1

Staying Healthy: Screenings, Tests and Vaccines

  • Annual Wellness Visit
  • Mammogram
  • Colonoscopy
  • Diabetes, Type 2
  • Diabetes - Injecting Insulin
  • Diabetes - Checking Your Blood Sugar
  • Smoking Cessation
  • Nutrition
  • Family Nutrition
  • Flu Vaccine
  • Coping with a Health Condition

Managing Chronic (Long Term) Conditions

  • Medication History
  • Hypertension
  • Incontinence
  • Fall Prevention 

HEDIS: EFFECTIVE & AVAILABILITY OF CARE MEASURES2

Diabetes

  • Chronic Kidney Disease (CKD)
  • Coping with a Health Condition
  • Diabetes - Checking Your Blood Sugar
  • Diabetes - Foot Care
  • Diabetes - Injecting Insulin
  • Diabetes - Insulin Pen (Injecting)
  • Diabetes - Smoking
  • Diabetes, Type 2
  • Diabetes - Carbohydrate Counting
  • Diabetes - Nutrition and Healthly Eating
  • Metabolic Syndrome: Hypertension, Prediabetes, Hyperlipidemia

Cardiovascular

  • Acute Myocardial Infarction

Prevention & Screening

  • Colonoscopy
  • Advance Directives

Obstetrics

  • Birth Control Options*
  • Breastfeeding
  • Childbirth
  • Cord Blood Storage Options
  • C-Section
  • Gestational Diabetes
  • Nutrition & Exercise During Pregnancy
  • Pain Relief for Childbirth
  • Prenatal Genetic Testing
  • Postpartum Depression
  • Vaginal Birth After C-Section (VBAC)

Measures through the CAHPS Health Plan Survey

  • Flu Vaccine
  • Smoking Cessation

Medication Management

  • Medication History

Musculoskeletal

  • Acute Low Back Pain
  • Chronic Low Back Pain

Respiratory

  • Chronic Obstructive Pulmonary Disease (COPD)
  • Asthma
  • Asthma - Cold & Flu Season
  • Asthma Action Plans
  • Asthma and Dust
  • Asthma and Exercise
  • Asthma and Pets
  • Asthma and Smoke
  • Asthma and Strong Smells
  • Asthma Peak Flow Meter
  • Inhaler - Dry Powder Disc (DPI)
  • Inhaler - Metered Does (MDI)
  • Inhaler - Pediatric Dry Powder Disc (DPI)
  • Inhaler - Pediatric Metered Does (MDI)
  • Inhaler - Spiriva Handihaler
  • Nebulizer (Adult)
  • Nebulizer (Child)


additional Suites

Find out more about our other Payer Program Suites and how they engage your members to control costs:


1 "Five-Star Quality Rating System.” Centers for Medicare and Medicaid Services
2 "HEDIS Measures.” National Committee for Quality Assurance
3 Emmi survey of 11,000 respondents from January 2014 – January 2015
4 Analysis conducted by Delta Health Alliance
*in development

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