SummaCare’s Mission is to work with providers, members, and employers to provide a comprehensive community-focused health plan that maximizes service and choice. We are committed to a thorough and effective Quality Management Program that follows the principles of Continuous Quality Improvement. Each year we strive to improve the care and services that our members receive.
The major goals and objectives of our quality management program include promoting and building quality into the structure and processes of our organization and monitoring and working to improve outcomes. In 2012 the quality improvement program continued to focus on enhancing the customer experience and promoting preventative health and wellness through targeted interventions.
Ensuring prompt identification of opportunities for improvement with actions for resolution is a major goal for SummaCare. To assist members in obtaining preventive screenings and optimal care for chronic conditions such as diabetes and cardiovascular diseases, we continued our annual Preventive Health Letter that identifies recommended services for you and your family and the Care Opportunity Letter. The Care Opportunity Letter is sent to members if we have not received claims by mid-year for recommended cancer screenings, blood pressure checks and other tests or services. The Care Opportunity letters are intended to remind and encourage our members to contact their physicians to obtain the care they need. The letters are followed up by a reminder phone call later in the year for members with continued care opportunities. We are also piloting other forms of outreach to members to determine additional effective ways to help members get the care they need.
The healthcare industry’s Healthcare Effectiveness and Data Information Set (HEDIS) provides standardized performance measures and comparisons against national benchmarks. Using HEDIS results, SummaCare monitors its quality improvement program performance and initiates efforts to improve performance when indicated. HEDIS results measured in 2012 for 2011 performance identified SummaCare’s strengths and opportunities for improvement. For Medicare, we had significant improvement in our HEDIS diabetic nephropathy screening and HbA1c control measures. In addition, our controlling high blood pressure rate exceeded the 90th percentile.
For the PPO commercial population, HEDIS rates are improving over time. Our HEDIS anti-depressant medication management, imaging for low back pain, and controlling blood pressure measures all fell within the 90th percentile. Our greatest opportunity for improvement is chlamydia screening. SummaCare is working with OBGYN providers to facilitate improvement in chlamydia screening.
For more information on our Quality Management Program, visit the member section on the website. If you would like a summary of the annual program evaluation, call (330) 996-8754.