Health Plan Quality Improvement Planning Checklist

October 22, 2019

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 2020, 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.

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Q4 2019

Close Care Gaps
Reach out to members who are not meeting standards of care via mail, phone, or email to close care gaps and improve health outcomes.
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.
Conduct Preventive Care Outreach
Contact members to promote awareness and compliance with preventive care measures and screenings.
Measure and Analyze Data
Measure and analyze healthcare data to proactively prioritize and manage risks and improve health outcomes.
Assess Member Satisfaction with Provider
Measure members’ satisfaction and their general experience with provider services through a survey like CG CAHPS.

Q1 2020

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.

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Health Plan Quality Improvement Planning Checklist

Q4 2019

Q1 2020

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Health Plan Quality Improvement Planning Checklist

Q4 2019

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