Quality Improvement at WHA

Western Health Advantage's (WHA) Quality Improvement Program provides a framework for the Health Plan to continuously identify and make improvements in the many aspects of care and service delivered to members. The activities of the Quality Program span across various settings where members receive services including the physician's office, hospitals, behavioral health facilities, and pharmacy services.

WHA's Quality Improvement Committee (QIC) is responsible for oversight of WHA's quality improvement (QI) program. The membership of the QIC includes physicians from each of WHA's contracted Medical Groups including behavioral health services, WHA's Chief Medical Officer/Medical Director, and WHA staff responsible for quality, utilization management, member services, and pharmacy services.

The goals of the committee include, but are not limited to, ensuring that:

• care and service members receive meet the requirements of federal and state agencies;
• nationally recognized quality standards are met;
• member and provider concerns are addressed;
• opportunities to improve care and service are identified; and
• improvement activities are undertaken.

Each year WHA identifies opportunities to improve care and/or service. Those chosen as quality improvement projects are selected because they affect the largest number of members, are of high significance to members, have the potential for WHA to make significant improvement, or are required of WHA by regulatory/accrediting agencies. Quality improvement projects are frequently the result of issues raised by members through WHA's satisfaction surveys or through analysis of member/provider complaints. Many quality improvement projects are carried out in collaboration with the Medical Groups that provide care to WHA members, and the Health Plan is also involved in several statewide quality improvement projects. Some of the key quality improvement activities being addressed during 2006 are:

• Expansion of our diabetes, cardiovascular and asthma disease management programs
• Improving the process for handling claims issues as a means to increase member satisfaction
• Improving continuity and coordination of care with members? PCPs following an inpatient stay or emergency room visit
• Increasing immunization rates for children and adolescents
• Increasing the screening rates for breast and cervical cancer
• Improving the timeliness and frequency of prenatal and postpartum care
• Increasing the rate at which diabetics obtain eye exams and have recommended lab tests completed
• Increasing member engagement through interactive health assessment and tracking tools
• Increasing member and provider use of WHA?s website to obtain eligibility information, register complaints, obtain clinical information and as a resource for health promotion activities and information.

Quality improvement activities include reporting of clinical performance in a number of areas. The results of this type of reporting are included in the California HMO Report Card and can be found on the website: www.dmhc.ca.gov.  Information on WHA?s Quality Program is also included on WHA?s website at westernhealth.com. Additional information and WHA?s progress toward meeting goals is available upon request through WHA?s Quality Department.

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