Quality Improvement (QI) Program

The Quality Improvement (QI) program is an important part of your Health Plan. The QI department supports our goal of improving member healthcare.

The QI Program monitors the quality of care and services provided in the areas below:

Making sure members get the care they need, when and where they need it
Making sure that members are receiving quality care
Cultural needs of our members
Member satisfaction
Member/Patient Safety and Privacy
Offering a wide variety of provider specialties
Health plan services members are using

The goal of the QI program is to improve member health. This is achieved through many different activities.

Some of our Quality Improvement goals include the following:

Good health and quality of life for all members
Care provided by Plan Healthcare Providers meets industry-accepted standards of care
Plan customer service meets industry-accepted standards of performance
Provide members with Preventive Care reminders annually
Incomplete or duplicate services will be kept to a minimum through QI activities across Plan departments
The Member experience will meet the Plan’s expectations
Compliance with all State and Federal laws and regulations
Evaluate the quality of health care through HEDIS® (Healthcare Effectiveness Data and Information Set). These scores tell us when you have received the type of care you need.
Check out our HEDIS® rates and results here (information coming soon).

Click here (information coming soon) if you would like to learn more about our Quality Improvement activities.

Ambetter from NH Healthy Families' Quality Improvement (QI) Program focuses on preventive health. The program creates plans, puts those plans into action, and measures efforts to improve your health and safety.

The QI Program strives to make a difference in health outcomes. It develops actions to improve member and provider satisfaction. Ambetter from NH Healthy Families involves providers within our plan. The providers assist with developing and monitoring activities of the QI Program as well as providing insight into preventive health resources and information.

For questions about the QI Program and our progress on meeting goals, call the Member Services department at 1-844-265-1278 (TTY 1-855-742-0123).

The QI Program also reviews services provided to our members. We have clinical practice guidelines for certain conditions. If you would like a copy of these guidelines or need more information about programs call us at 1-844-265-1278 (TTY 1-855-742-0123).

Information and/or a full copy of Ambetter from NH Healthy Families' current QI Program Description is available upon request.

Ambetter from NH Healthy Families cares about you and the healthcare you receive. In 2016, we completed many quality improvement projects to help us see if our members are completing their recommended care and our participating providers are giving the recommended services to our members.

HEDIS® (Healthcare Effectiveness Data and Information Set) is a tool that helps us make sure our members are getting the care they need. We compare our results to the same results of other health insurance plans. Every year we like to share some of the quality improvement efforts and the results of our HEDIS monitoring with you and let you know what we’re doing to improve your health.

We help our members get their recommended preventive exams and recommended medical care for chronic conditions. We also remind our Participating Providers that their patients are due or past due for their recommended screenings. In 2016, if you were past due for a service you and/or your doctor may have received one of our educational letters or calls to remind you about checkups you should have. Our outreach programs help you be the healthiest you can be.

In 2016, Ambetter from NH Healthy Families completed member and provider focused improvement interventions in the following areas:

Anti-Depressant Medication Management
Breast Cancer Screening
Chlamydia Screening
Cervical Cancer Screening
Comprehensive Diabetes Care

Due to the newness of the Ambetter from NH Healthy Families, 2016 marked the first year HEDIS data was collected.

The tables below will show some of our 2016 quality improvement successes and some of our opportunities for improvement for 2016.

2016 Quality Improvement Highlights

MEASURE	2016	BENCHMARK ACHIEVED*
Comprehensive Diabetes Care (CDC): HbA1c Testing	93.40%	90^th
Comprehensive Diabetes Care: Eye Exam	52.36%	75^th
Chlamydia Screening in Women-Total	50.35%	75^th
Controlling High Blood Pressure	66.67%	75^th

* National Quality Compass Benchmark - Measurement Year 2015

2016 Quality Improvement Opportunities

MEASURE	2016	BENCHMARK ACHIEVED*
Cervical Cancer Screening (CCS)	45.74%	Did not achieve benchmark
Antidepressant Medication Management(AMM): Acute Phase	63.11%	25^th
Antidepressant Medication Management(AMM): Continuation Phase	44.66%	10^th
Comprehensive Diabetes Care CDC): Medical Attention for Nephropathy	86.56%	25^th

* National Quality Compass Benchmark - Measurement Year 2015

At Ambetter from NH Healthy Families, your health means the world to us. As you can see, we are working hard to make sure you get the best care you need, when you need it. We are always trying to improve and your comments are important to us.

Please call Member Services or contact us to tell us how we can better serve you.

Call Member Services at 1-844-265-1278 (TTY 1-855-742-0123).

Ambetter from NH Healthy Families cares about you and the healthcare you receive. In 2017, we completed many quality improvement projects to help us see if our members are completing their recommended care and our participating providers are giving the recommended services to our members.

Ambetter from NH Healthy Families supports continuous ongoing measurement of clinical and non-clinical services and interventions. The Health Plan assesses the Member experience by soliciting feedback from members, authorized representatives, and caregivers. We review and analyze the satisfaction surveys, member appeals and grievances, telephone services response times and assessing the practitioner network.

We help our members get their recommended preventive exams and recommended medical care for chronic conditions. We also remind our Participating Providers that their patients are due or past due for their recommended screenings. In 2017, if you were past due for a service you and/or your doctor may have received one of our educational letters or calls to remind you about checkups you should have. Our outreach programs help you be the healthiest you can be.

In 2017, Ambetter from NH Healthy Families completed member and provider focused improvement interventions in the following areas:

Anti-Depressant Medication Management
Breast Cancer Screening
Chlamydia Screening
Cervical Cancer Screening
Comprehensive Diabetes Care

The tables below will show some of our 2017 quality improvement successes and some of our opportunities for improvement for 2017-18.

2017 Quality Improvement Highlights

MEASURE	2016	2017	BENCHMARK ACHIEVED*
Comprehensive Diabetes Care: Eye Exam	52.36%	55.47% (↑)	75^th
Controlling High Blood Pressure	66.67%	69.10% (↑)	90^th
Pharmotherapy Management of COPD Excaberation-Cortiosteroid	80.00%	84.38%	90^th

* National Quality Compass Benchmark - Measurement Year 2017

2017 Quality Improvement Opportunities

MEASURE	2016	2017	BENCHMARK ACHIEVED*
Cervical Cancer Screening	45.74%	53.04 (↑)	Did not achieve benchmark
Colorectal Cancer Screening	N/A	41.36% (↓)	Did not achieve benchmark
Comprehensive Diabetes Care (CDC): HbA1c Testing	93.40%	88.81% (↓)	25^th
Antidepressant Medication Management(AMM): Acute Phase	63.11%	59.35% (↓)	25^th