Health Plan Quality Improvement Planning Checklist

November 18, 2020

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While the global pandemic has undoubtedly challenged many QI intiatives this year, health plans must ensure they are ready to meet the ongoing challenges in 2021.  Now is the time to plan so performance issues can be identified and improved prior to regulatory submissions and to support 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 2021, SPH offers solutions to help health plans evaluate and meet your 2021 Quality Improvement objectives. Review our quick-reference checklist below to assist with your HEDIS® and Quality Improvement planning initiatives.

Printable PDF version


Q4 2020

  • Address Care Gaps and Preventive Care
    Utilize a targeted approach to reach out to members promoting compliance with preventive care and closing care gaps. Drive actions most effectively via a persona-driven approach that targets members by engageability, health status, and outreach modality preference.
  • 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.
  • Assess Member Satisfaction with Provider
    Measure members’ satisfaction and their general experience with provider services through a survey like CG CAHPS.
  • Update Your Member Communications
    Include in your member communications any changes that go into effect after Jan. 1.

  • Prepare for Increased Weighting of CAHPS Scores
    Customer experience measures are increasing from 32% of a Star rating to 57% in 2023. The 2023 Star ratings are based on CAHPS surveys conducted in 2022, which capture member experience from 2021. Now is the time to implement changes to address current low-scoring areas such that improvements will be experienced by members in 2021.

Q1 2021


Contact us for a free evaluation and experienced guidance
to help meet your 2021 Quality Improvement objectives.


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