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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 doctors 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
  • 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
  • Addressing racial and ethnic disparities in health care that could negatively impact quality care
  • Monitoring the effectiveness of our programs
  • Studying the accessibility and availability of our network providers
  • Monitoring the overuse and underuse of services for our Medicare members
  • 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 2018:

  • 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 continued to measure member satisfaction and delivered member initiatives including the redesign of the member website. This helped to enhance the user experience. Also, through the online provider directory, members can locate in-network providers.
  • Through the Disease Management Program, we continued to provide valuable information to help members with education, support and behavior change.  This, in turn, helps them better manage their conditions.
  • We collaborated with medical and behavioral health to monitor and improve continuity and coordination of care.
  • We developed a Population Health Management clinical model that provides structure and resources to support members’ needs.
  • We improved our patient safety program to help our members make informed health choices.

1HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).
2Quality Compass is a registered trademark of NCQA.

Your behavioral health needs are important to us

Even as the opioid crisis continues to claim lives and harm families and communities across the country, Innovation Health is seeing progress on stemming the tide of opioid misuse. We also continue to help our members with their mental health needs.

The multi-pronged strategy, which includes collaboration with key industry and other stakeholders, is working. Progress in 2018 included:

  • A decrease in the average amount of opioids prescribed per month
  • A significant increase in the percentage of members with chronic pain treated with non-opioid approaches like physical therapy and non-steroidal anti-inflammatory drugs
  • Increasing the use of evidence-based treatment for members struggling with opioid use disorder, which includes counseling and medications. This helps our members find an effective path to end misuse. 
  • Increased awareness and distribution of naloxone, a rescue medication for opioid overdoses, allowing members to learn to live without opioids
  • Growing our Utilization Management Transformation (UMT) programs
    • UMT referrals increased to address social determinant needs and peer support
  • Producing 54 “Let’s Talk” videos on behavioral health information topics
  • Expanding the Measure, Act, Prevent (MAP) program which provides peer support to members who have gone through substance use disorder rehabilitation
  • Changing practitioner reimbursement to promote care coordination across behavioral health (BH) providers and between BH and medical providers 

Additional behavioral health program improvements in 2018 included:

  • Improved treatment for depression by helping members stay on their antidepressant medication
  • Helped improve attendance at follow-up appointments for children with attention deficit hyperactivity disorder (ADHD)
  • Expanded televideo services
  • Increased member telephonic access to behavioral health services after hours
  • Achieved favorable member satisfaction rates in our UMT programs

Our plans for 2019:

  • Introduce online recovery services to complement traditional care and chat therapy counseling
  • Execute new streamlined clinical care model
  • Maintain clinical improvement outcomes for members with ADHD, depression or substance use disorder diagnoses
  • Encourage broader use of televideo services
  • Continue to focus our efforts to help fight the opioid epidemic
  • Increase the use and availability of online assessment and informational tools


We take our accreditation by the 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 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.

       Page last updated: Oct 22, 2019

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