• Quality Program Summary

Quality Program Summary

Quality Program Summary | Clinical Quality Improvement | Service Quality Improvement | Improve Healthcare Quality

Senior Whole Health Quality Program Summary

It is Senior Whole Health's mission to maximize the quality of life, health, security and independence of our members. It is critical to that mission that we provide members with top quality care and service. The company has established a Quality Improvement Team, structure and contributing resources to deliver on this goal. The Quality Improvement Team monitors nationally established indicators of business performance, and compares them to benchmarks to identify opportunities for improvement.

As the opportunities are identified, projects are proposed, prioritized, implemented and managed to attain the desired improvements. As the programs take effect, the quality metrics continue to be monitored to make sure the desired performance is achieved. Over time, current projects are sustained and new opportunities are identified and prioritized.

By using this approach, Senior Whole Health is continuously working to improve the care and services it provides its members. In 2017, SWH became accredited by the National Committee for Quality Assurance (NCQA) which is a testament to the quality SWH provides for our members. In addition, SWH was awarded 4.5 out of 5 Stars by the Centers for Medicare & Medicaid Services (CMS) in 2017. As we attain these achievements, the member's health and quality of life will improve, too.

Clinical Quality Improvement Examples

Health Management

SWH has started Health Management programs to help members with diabetes and cardiovascular diseases such as high blood pressure and coronary artery disease to better self- manage their conditions. In 2018, SWH will be adding Chronic Obstructive Pulmonary Disease (COPD) and Depression Health Management programs.

Members in these programs can receive mailed materials, telephonic coaching, and, in some cases, home visits. The goal of these programs is to improve member self-management of the condition, educate as needed on the disease and help members be as healthy as possible. SWH monitors member’s health by looking at measures which include medication compliance, blood pressure and blood sugar levels, or yearly eye screenings for members with diabetes.

If you know of a member who might qualify for these programs, call member services.

Care Transitions

At times, Senior Whole Health members need the specialized care only found in the inpatient or skilled nursing setting. As members experience these transitions in and out of different settings, there are quality and safety risks associated with the handoffs that occur.

The goal of this project is to help facilitate these transitions by working with the member to understand their care needs, and working with their doctors who provide them. If this is successful, the member will have a good recovery, better outcomes and a lower chance of readmission.

Success of the program is measured by whether members see their primary care doctor after discharge and whether they stay safely in their home setting after discharge.

Complex Case Management

Many Senior Whole Health members have multiple, complicated medical conditions that need special care and attention. Such members are enrolled into the Complex Case Management program, where their needs are assessed and specialized Member Centric Care Plans are developed.

Depending on the needs identified in the Care Plan, the member may be eligible for special care and services arranged by the plan. As these services are provided, the member's health and ability to live independently improve.

The program is assessed by an evaluation of the services provided to the member, and whether those services help improve the member's health.

Service Quality Improvement Examples

Transportation

It's very important that members seeking care have access to the transportation needed for them to keep their appointments. This project is working to improve the transportation network serving our members. The goal is for members to be able to access dependable transportation services with no difficulty.

Member Services Improvements

Senior Whole Health has many interactions with our members, such as calls and home visits. We are always working to monitor these interactions, and to identify ways to improve them. Our goal is to have our members highly satisfied with the services we provide.

In 2017, SWH began a new program for the Call Center called Single Call Resolution. The goal is for the Central Services group to handle basic calls to avoid transferring calls to Member Services or other departments. The staff in Central Services has received additional training so they are able to manage member’s requests.

What You Can Do to Help Improve Healthcare Quality

Members:

  • Make sure to see your doctor for the care you need
  • Understand all of your health needs and the treatments provided for them
  • Bring a list of questions to your doctor’s visits
  • Be as healthy as possible by being more active, eating well, getting immunized and taking your medicines
  • Bring a copy of your medication list to all your doctors’ visits and review with your doctor

Providers:

  • Spend enough time with your patients to make sure you understand their needs
  • Follow up on gap opportunities provided to you by Senior Whole Health such as Mammograms
  • Work with Senior Whole Health to ensure coordinated and quality care is provided to the member
  • Review and reconcile members medications with them at every visit

For more information about the Quality Program, including a complete description and the latest evaluation, contact the Quality Department at 617-551-2630.

 

Last Updated 04/11/2018