What is Quality improvement program

Overview

SHP maintains an active Quality Improvement Program (QIP) that provides structure and processes for our ongoing commitment to proved and continually improve upon the care and services that are offered to our members. The QIP goals are based upon our ongoing evaluation of programs and services offered; regulatory, contractual and accreditation requirements; and strategic planning initiatives.

Program Goals

The goals of the QIP include but are not limited to:

*  Develop, implement and maintain systems and programs that monitor, measure and improve the health care outcomes and service levels within identified member populations

*  Ensure access to qualified, competent providers

*  Engage member/legal guardians in the education, managing and improving their current health state

*  Promote a safe, culturally-sensitive delivery of health care that promotes appropriate, efficient and effective use of resources and supports the physician-patient relationship

*  Ensure the coordination of and transition of care needs are identified and provided to our

members

*  Ensure compliance with standards as required by contract, regulatory statutes and accreditation agencies

*  Encourage and use feedback from stakeholders to improve reporting methods and information availability in relevant, timely manner

*  Utilize a multidisciplinary committee approach to facilitate the success of the QIP goals, improve organizational communication and ensure the participation of contracted community providers in the development/review of the clinical aspects of programs and services

The QIP works to achieve these goals through an evaluation process of clinical and service outcomes by measuring the effectiveness of internal processes and ongoing, active improvement interventions. Functional aspects of the QIP that contributes to a high level of clinical and service outcomes include, but are not limited to:

o Care Management Programs:

SHP’s Healthy Pregnancy Program; SHP’s High-Risk Pregnancy Program;

Children’s Wellness Program;

Diabetes Management Program; CHF Management Program;

Chronic Care Improvement Program; Chronic Kidney Disease Program.

o Preventative Care and Clinical Practice Guidelines

o Measurement of Clinical and Service Quality; HEDIS, CAHPS®, Provider Satisfaction Survey, Member Satisfaction Survey, and key quality metrics

o Care Management and Model of Care for Special Needs Plan (dually eligible) members

SHP offers disease management programs to help you understand and manage a chronic health condition you may have. Our team of health care professionals, including your PCP, will help you with your health care needs. They will arrange for home health care and medical supplies needed to manage your condition, if needed.