Quality Improvement Program
 

• The health plan actively focuses on the performance awareness, measurement, and improvement of the health care of all members.  Performance awareness begins with the development and distribution of routine preventive care and clinical care guidelines, and health management programs.  Using nationally recognized standards of care, guidelines are adopted/developed through a task force or physician committee.  On the website, you will find information on : preventive health guidelines, clinical care guidelines, health management programs.
  
  
• Performance measurement is handled in a variety of ways. The health plan actively evaluates all primary care and high-volume specialty physicians and their office sites for adherence to standards. Registered nurse reviewers perform onsite review of documentation in the medical record and office site preparedness. All information is evaluated by the medical director. The Facility, Medical Record Keeping, Medical Record and Focused Access/Safety Reviews each require a score of 80% to pass. Scores beneath 80% require corrective action. The audit tools used to assess these areas can be found on this website.

• The health plan completes measurement of its’ performance through annual HEDIS®* measurements, a core set of health plan performance measures, External Quality Review performance measures, HEDIS CAHPS®* member satisfaction surveys, and measurements of adherence/usage of our clinical guidelines. Results are then analyzed and presented to the QI/UM Committee for recommendations and interventions.
  
  
•  Performance improvement completes the process.  The health plan is actively involved in improving the health outcomes of our members. Examples include targeted mailings for annual mammography screenings, patient profiles, and health management programs for pregnancy, asthma and diabetes.  We are continually looking for ways to assist practitioners in empowering members to take better care of themselves and their families.

* HEDIS® and CAHPS® are registered trademarks of the National Committee for Quality Assurance.

For a description of the quality improvement program for Unison Health Plan, information on how well we are meeting our goals or information on our practice guidelines, please write to: Unison Health Plan, C/O UAS, Department of Quality Improvement, 1001 Brinton Road, Pittsburgh, PA 15221