Quality Improvement Program

The Quality Improvement (QI) program reflects HMSA’s commitment to facilitate ongoing improvement in the delivery of high quality healthcare. The Quality Oversight Committee (QOC), which is a subcommittee of the HMSA Board of Directors, is charged with providing oversight for the QI program.

Highlights of HMSA's QI program are presented in an annual report called Pursuing Quality, which is sent to all participating physicians. Physicians may request a copy of this publication by writing to:

Provider Services

HMSA

P.O. Box 860

Honolulu, HI  96808-0860

Physicians may also obtain Pursuing Quality by visiting our website at www.hmsa.com or by calling a Provider Teleservice Representative at 808-948-6330 on Oahu or 1-800-790-4672 from the Neighbor Islands.

Purpose

The purpose of the QI program is to increase the quality of care for HMSA members by optimizing the delivery of cost-effective healthcare services. This goal is achieved by monitoring clinical care, clinical service and organizational service.

Quality Improvement (QI) Program Goal and Objectives

The goal of HMSA’s QI program is to monitor the clinical care, clinical service and organizational service provided to members while identifying opportunities for prioritizing, improving and implementing quality improvement activities.

Below are objectives of the QI program:

• Provide information and resources to members, providers and other stakeholders who can improve the process of care
• Implement population-based health management and pharmaceutical management programs
• Practice the principles of continuous quality improvement
• Reduce variations in care and clinical practice patterns

Quality Improvement (QI) Program Activities

The primary activities of the QI program focus on preventive care and disease management. These activities include:

• Data analysis and reporting, particularly for programs involving asthma care, diabetes treatment and screening programs (mammography, immunizations, etc.)
• Member satisfaction surveys, such as the annual Consumer Assessment of Health Plans Survey (CAHPS®)
• Accessibility standards and timeliness (see Accessibility Standards)
• Practitioner credentialing (see Provider Credentialing Requirements)
• Monitoring member complaints
• Utilization monitoring

Quality Improvement Committee (QIC)

The QIC is composed of practicing physicians who work with the QOC to administer the QI program. The QIC monitors the effectiveness of the QI program and receives progress reports regarding the following topics:

• Provider credentialing
• Member and practitioner satisfaction
• Utilization management
• Complaints and appeals
• Preventive health services
• Results of quality improvement studies

Quality Improvement (QI) Program Subcommittees

Several subcommittees support the objectives of the QI program and provide for a more systematic approach to managing the objectives of the QI work plan. These include the Disease Management, Physician Advisory, Member Satisfaction, Utilization Management, Care Coordination, and Pharmacy & Therapeutics Advisory committees.

Evaluation of the Quality Improvement (QI) Program

The QI program is evaluated annually to assess the extent to which the scope, methodology, and activities succeed in meeting performance standards as they relate to HMSA’s purpose, goals and objectives. Quality improvement activities are reviewed to determine their appropriateness, compliance with clinical standards, and impact on the quality of patient care and service rendered.

Evaluation of the QI program should result in

• Improved performance in the delivery of healthcare and services where the plan has identified problems and corrective actions have been implemented.
• Identifying the plan's performance in quality improvement as it relates to improved outcomes and patient satisfaction using (Healthcare Effectiveness Data and Information Set) HEDIS 3.0 measurements and other metrics.
• Ensuring an appropriate level of effectiveness and efficiency in the plan's performance.

Revision History