Quality Improvement Strategy
eternalHealth is committed to providing the highest quality healthcare and safety for our members by ensuring that our members have access to the healthcare services they need. The goals of our Quality Improvement Strategy are to:
- Provide our members with access to receiving the highest level of healthcare they need and deserve.
- Provide ongoing evaluation of our processes and providers to improve quality, safety, and access for our members.
- Comply with all applicable laws and regulations relevant to our efforts to improve the quality and safety of healthcare for our members.
eternalHealth will accomplish these goals by:
- Implementing measures and managing the accessibility, and quality of healthcare available to our members.
- Engaging with providers and other healthcare professionals to improve the quality of healthcare services rendered to our members.
- Offering our members evidence-based population health programs and services.
- Supporting our members and their doctors with the information they need to make the best possible decisions.
- Continuously evaluating and updating our policies and procedures to align with the latest standards for clinical practice.
Quality Improvement Activities
eternalHealth will implement practices and activities to ensure our members will receive the best quality care through services provided by our partners and providers. eternalHealth will evaluate the quality of services and member satisfaction by:
- Reviewing member satisfaction surveys on services and care received from our internal and external partners.
- Evaluating how well our network provides coordinated services for our members.
- Collecting data on overused and underused healthcare services.
- Promoting member use of preventive care services, to ensure they receive the right service, at the right time, and with the right provider.
eternalHealth will continuously review our provider network to ensure:
- All members have access and availability to the providers in our network.
- All providers are being credentialed and recredentialed in a timely and efficient manner.
- All racial and ethnic disparities are eliminated in both the quality of healthcare services provided and the access to these services.
- Feedback is sent to our providers based on satisfaction surveys and performance metrics, as it relates to regulatory and organizational goals, in order to promote and support practice improvement.
Meeting Our Quality Improvement Goals
eternalHealth will follow all regulatory quality improvement practices to ensure implementation of best practices to promote the highest quality of care outcomes for our members. These measures will include, but are not limited to:
- Collection of clinical information from our providers to ensure we are meeting The Centers for Medicare and Medicaid (CMS) Healthcare Effectiveness Data and Information Set (HEDIS) Performance measures.
- On-going review of our data with our providers to ensure we are providing optimal evidence-based care for our members.
- Evaluation of the plan’s ability to ensure our members are receiving quality and evidenced-based care.
- Leveraging our world-class data science capabilities to analyze clinical and claims data.
Case and Disease Management
eternalHealth will collaborate with our providers to provide care and disease management services for our members. This will include:
- Coordinating with providers to safely transition our hospitalized members back into the community.
- Educating members on the importance of following up with community-based providers to reduce the need for hospital readmission.
- Working with members to help them effectively manage common chronic diseases such as hypertension, asthma, and diabetes.
- Accessing community resources to help members better manage the key social determinants of health (SDH) that may impact their ability to care for themselves and access the right healthcare services.
Quality Improvement Programs for Medications
eternalHealth will implement quality improvement programs which will focus on improving appropriate medication use, such as:
- Medication-related safety and monitoring solutions that target non-opioid, high-risk drug classes. These solutions focus on preventing polypharmacy and inappropriate use and abuse of controlled substances, including opioids.
- Targeted strategies for monitoring opioid use with the goals of identifying and working to mitigate any cases of opioid misuse and abuse.
- A program focused on monitoring and improving adherence with highly effective medications, including oral diabetes medications, cholesterol lowering medications, and blood pressure lowering medications.
- Reconciliation of members’ medications after being discharged from a hospital or a post-acute care facility, to decrease and prevent medication-related errors and adverse events.