Medicare Health Plans >> Quality Program

Medicare Health Plans

Quality Program

It is the policy of Welborn Health Plans (WHP) to provide the highest level of quality care and service while striving to continuously improve the care and service received by members. The Quality Management (QM) program is designed to objectively monitor, evaluate and positively influence the provision and cost of medical care and services accessed through WHP and its providers while complying with applicable laws, regulations and accrediting requirements. The QM Program is reviewed and evaluated annually.

The QM program monitors, analyzes, tracks and disseminates data to WHP areas and identifies ways to improve members’ care and services and to achieve desired health outcomes. The QM program is comprehensive in scope, utilizing data from all areas of care and service and documentation of monitoring techniques, analysis and interventions. The program evaluates the quality of care and service in the hospital inpatient, outpatient, and ambulatory and extended care settings. The program incorporates data from claims, HEDIS, utilization, sentinel event logs, quality logs, pharmacy sources and member and provider survey instruments to develop and enhance programs such as case management, disease management, member education, provider education, clinical and preventive guidelines, as well as service improvement activities.

 

H3044_H1558_WHPWeb (10/2009)