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Health Plan Quality Improvement Checklist

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Multiple regulatory programs require health plans to report on their efforts to: improve health outcomes, prevent hospital readmissions, ensure patient safety and reduce medical errors, and implement wellness and health promotion activities. As you plan for 2021, SPH offers solutions to help health plans evaluate and meet these Quality Improvement objectives. Review our quick-reference checklist below to assist with your HEDIS ® and Quality Improvement planning initiatives. Q4 2020 Q1 2021 ❑ Address Care Gaps and Preventive Care Utilize a targeted approach to reach out to members promoting compliance with preventive care and closing care gaps. Drive actions most effectively via a persona-driven approach that targets members by engageability, health status, and outreach modality preference. ❑ Assess Customer Service Satisfaction Assess members' customer service satisfaction to evaluate effectiveness and implement needed improvements. ❑ Boost Retention and Renewal Remind members to confirm re-enrollment and assess reasons for those not planning to re-enroll. ❑ Assess Member Satisfaction with Provider Measure members' satisfaction and their general experience with provider services through a survey like CG CAHPS ® . ❑ Update Your Member Communications Include in your member communications any changes that go into effect after Jan. 1. ❑ Prepare for Increased Weighting of CAHPS Implement changes to address current low scoring areas. Customer experience measures increase in 2023 to represent 57% of Star Ratings. These ratings are based on CAHPS surveys conducted in 2022 which capture member experience from 2021. ❑ Welcome New Members Build member satisfaction and loyalty from the start with new member welcome calls. ❑ Conduct Health Risk Assessments Identify members' health status to initiate and expedite effective healthcare management. ❑ Evaluate Disenrollments Survey "disenrollees" to understand their perspective. This can be important for your retention and renewal efforts. ❑ Promote Medication Therapy Management Educate members about the guidelines and benefits of your MTM program to promote awareness and compliance. ❑ Consistently Engage with Members Develop a plan for continuous member engagement and outreach to improve satisfaction, loyalty, and retention. ❑ Assess Your Provider Network Determine provider satisfaction with the health plan, assess availability of care to members, and update provider information. ❑ Meet Performance Guarantee Requirements Gauge the satisfaction of your clients' employees to meet contractual guarantees and avoid financial penalties with a Performance Guarantee Survey program. Contact us for a free evaluation and experienced guidance to help meet your 2021 Quality Improvement objectives info@SPHAnalytics.com | 866-460-5681 TM Years 3 + Quality Improvement Planning Checklist ✓ SPHAnalytics.com © 2020 Symphony Performance Health, Inc. All Rights Reserved. 17.7.5 HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

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