Quality has its “own” language and utilizes many acronyms, which the CEO understands from personal experience. She has directed Quality Departments and programs that resulted in a local health plan receiving Excellent Accreditation for five consecutive years and ranking in the Top 25 Medicaid Managed Care Health Plans nationally. A regional plan ranking in the Top 25 nationally is no easy task! So she understands how to optimize State resources, health plan associates, State Pay for Performance, and CMS Star financials by achieving and, more crucially, “sustaining” member compliance, satisfaction, and overall quality of care.
Allow QIPH-iCare, LLC. to partner with you! We will succinctly demonstrate how to leverage the Annual Member Report Card tool, which genuinely works and eliminates waste when enhancing your company’s member outcomes, quality of care, and clinical measure outcomes, including HEDIS outcomes. You do not need to hire additional staff to administer the Annual Member Report Card because it is that efficient! A significant perk is that the Annual Member Report Card can be scaled to all products and/or lines of business (Medicaid, Medicare, Commercial, Exchange). It can also be scaled to accommodate both low-tech and high-tech quality teams. It is simple to adopt and has a major impact on your rates!
- “Efficiently” Closing Healthcare Gaps – 20+ years of experience
- Extraction of medical records – 20+ years of experience
- Quality Operations of Information Systems – 20+ years of experience
- Enhancing your HEDIS™ reporting procedure – 20+ years of experience
- Trilogy Document Preparation using Six Sigma with 100% on NCQA Audits
- Best Method to Focus on State, CMS, and NCQA Measures Concurrently
- Initiatives for Quality Improvement – 20+ years of experience
- NCQA Accreditation – 20+ years of experience
- Quality Department Structure – 20+ years of experience
- Quality Department Project management of internal audits – 20+ years of experience
- Improving Member Health Status
- Increasing Member Gap Closure Rates and Satisfaction based on science (i.e., Proven Motivation Theories such as the Economics Motivation Theory and Maslow’s Hierarchy of Needs Motivation Theory)
- Closing Member Gaps by 4th Quarterly Annually
- Decreasing Member Abrasion
- Quality Department Leaders at any of the organizations below:
- Managed Care Organizations & Leaders
- Accountable Care Organizations & Leaders
- Provider Owned Organizations & Leaders
- Patient-Centered Medical Home & Leaders
- Provider Offices & Leaders
- Consultative Services
- Leasing the Annual Member Report Card©
- So, how “exactly” does each department in the organization contribute? Every function we coordinate and manage in the Quality Department impacts all departments within the Company. Therefore, every department plays a role in the accreditation and regulatory audit processes, the HEDIS process, the Member Satisfaction (CAHPS) process, the Member Safety Processes, the Data Processes and Reports, and/or the Quality Project Management processes.
Medicaid, Commercial, Medicare and Market Place Exchange Training and Education for Staff
Medicaid
Medicare
Commercial
