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Quality Management & Improvement Efforts

Quality improvement strategy

We are working hard to improve the service, quality and safety of health care. One way we do this is by measuring how well we and others are doing.

We work with groups of doctors and other health professionals to make health care better.

Our clinical activities and programs are based on proven guidelines.

We also give you and your doctor information and tools that may help you make decisions.

Program goals

We aim to:

  • Meet the members’ health care needs
  • Measure, monitor and improve clinical care and quality of service
  • Institute company-wide initiatives to improve the safety of our members and communities
  • Address racial and ethnic disparities in health care
  • Make sure we obey all the rules, whether they come from plan sponsors, federal and state regulators or accrediting groups

Program scope

We work to make your health care better by:

  • Developing policies and procedures that reflect current standards of clinical practice
  • Reviewing preventive and behavioral health services, and how care is coordinated
  • Monitoring the effectiveness of our programs
  • Studying the accessibility and availability of our network providers
  • Performing credentialing and recredentialing activities
  • Assessing member and provider satisfaction

Program outcomes

Each year we check to see how close we are to meeting our goals. Here's what we did in 2016:

  • We collected data on a set of clinical measures called the Healthcare Effectiveness Data and Information Set (HEDIS®1), as applicable. We shared the results with the National Committee for Quality Assurance (NCQA) Quality Compass®2. NCQA makes the results public. Each year, we use the results to set new goals and improve selected measures.
  • We asked member how satisfied they are with Innovation Health.  We met the cultural and language needs of our members.
  • We surveyed member access to care and educated providers on our appointment availability standards.
  • We improved our patient safety program and:
  • – Provided information to members during National Patient Safety Week.
    – Posted member patient safety information and tools on our website.

Your behavioral health needs are important to us

Last year we took several steps to address the dramatic rise in opioid addiction – to painkillers and to illegal drugs such as heroin.  To help avoid addiction, we increased communications to our providers to encourage alternatives to opioids for treating pain. We also asked providers to follow prescription practices that help to avoid opioid dependence.  If dependence has already developed and is identified during a case review, our clinicians perform a risk assessment. Members and providers are urged to consider naloxone as a rescue medication in the event of an opioid overdose.

Additional program improvements in 2016 include:

  • An improvement in the way we identify members with extensive behavioral health needs to increase the effectiveness of our program
  • Activities to help members with autism spectrum disorder
  • Follow-up care for children prescribed ADHD medications 
  • Introducing three new videos in our ‘It Only Takes a Minute’ series on YouTube. The videos raised awareness and reduced stigma related to addiction, suicide and self-esteem.

See more behavioral health information

Accreditation

We take our accreditation by the National Committee for Quality Assurance (NCQA) seriously. It's how we show our commitment to improving your quality of care, access to care and member satisfaction.

Get more information about our NCQA accreditation at http://www.ncqa.org.

The Partnership

Together, Aetna and Inova are taking a new approach to the way health care is offered. With this innovative partnership, these two industry leaders aim to provide more efficient and effective patient care at a more affordable cost. By joining the right medical professionals with the right technology, patients receive the benefit of quality, personalized health care.

Disclaimers

Innovation Health is a HMO, PPO plan with a Medicare contract. Enrollment in our plans depends on contract renewal. 

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

Innovation Health Medicare’s pharmacy network offers limited access to pharmacies with preferred cost sharing in: rural Missouri. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use.

For up-to-date information about our network pharmacies, including pharmacies with preferred cost sharing, members please call the number on your ID card, non-members please call 1-866-471-9374 (TTY: 711) or consult the online pharmacy directory at http://www.innovationhealthmedicare.com/pharmacyhelp.

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. 

Participating physicians, hospitals and other health care providers are independent contractors. They're neither agents nor employees of Innovation Health. The availability of any particular provider can't be guaranteed. Provider network make-up is subject to change. 

       Y0123_4006_10831 Approved 12/7/2017

       Page last updated: May 30, 2018

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