Quality Improvement Program

DHMC’s Quality Improvement Program is designed to support the mission of DHMC by promoting the delivery of high quality accessible healthcare services that will enhance or improve the health status of DHMC members.

The Quality Improvement Program provides a formal process to objectively and systematically monitor and evaluate quality and safety of clinical care and service utilizing a multidimensional approach measured through different performance dimensions. These dimensions include appropriateness, efficiency, effectiveness, availability, timeliness and continuity. This approach enables DHMC to focus on opportunities for improving operational processes, member and provider satisfaction as well as health outcomes.

The quality DHMC seeks to achieve through implementation of the Quality Improvement Program, is to deliver the “right care or service, at the right time, by the right staff” in the most appropriate place and to continuously improve the care, safety and service provided to our members.

The quality improvement process is based on a continuous improvement cycle of measurement, assessment, planning, implementation and evaluation. Data is systematically collected prospectively, concurrently and/or retrospectively on clinical, safety, preventative and service performance. Data is analyzed, summarized and presented as information with recommendations to the Quality Management Committee. Quality Improvement works collaboratively with various DHMC departments to develop and implement initiatives targeted at improving clinical care, outcomes, safety and service.

QI Activities Summary

In 2016 QI activities focused on diabetes, prenatal/postpartum care, member satisfaction and preventive health measures for both children and adults. QI team members collaborated with Ambulatory Care Services ((ACS) through various work groups in diabetes, weight management, children’s preventive health, and preventive cancer screening. We worked with school-based health centers in the Denver Health system to improve the delivery of well-child care to our Medicaid members enrolled in Denver Public Schools. QI collaborates with Healthy Communities and other outreach programs to assist families in finding appropriate services and referrals, establishing medical homes, and access preventive services. Additionally, QI continues to make improvements in obtaining real time data from the warehouse and registries, which is helpful in the many interventions conducted throughout the year.

Clinical Practice Guidelines

Denver Health Medicaid Choice (DHMC) adopts and disseminates clinical practice guidelines to assist providers and members in making decisions about appropriate health care for specific clinical conditions. Our clinical practice guidelines produce care recommendations to support the provision of high-quality, evidence-based care, based on existing clinical guidelines and recognized scientific evidence. We utilize and reference expert professional and clinical sources to ensure our guidelines reflect the highest level of evidence based content. Clinical practice guidelines are also used to guide efforts to improve the quality of care for our members and facilitate implementation of evidence-based clinical recommendations into practice.

Preventive Guidelines:

Clinical Guidelines:

Quality Improvement Annual Summary Reports

HEDIS is a tool used by more than 90 percent of America's health plans to measure performance on important dimensions of care and service. Altogether, HEDIS consists of 80 measures across 5 domains of care. Because so many plans collect HEDIS data, and because the measures are so specifically defined, HEDIS makes it possible to compare the performance of health plans on an "apples-to-apples" basis. Health plans also use HEDIS results themselves to see where they need to focus their improvement efforts.

HEDIS measures address a broad range of important health issues. Among them are the following:

  • Asthma Medication Use
  • Persistence of Beta-Blocker Treatment after a Heart Attack
  • Controlling High Blood Pressure
  • Comprehensive Diabetes Care
  • Breast Cancer Screening
  • Childhood and Adolescent Immunization Status
  • Childhood and Adult Weight/BMI Assessment
  • Well Child Visits

Quality Improvement Program Descriptions:

SFY 2015-2016 Work Plan

QI Department develops a Work Plan annually. The Work Plan covers the scope of the QI Program and includes:

  • Written measurable yearly objectives for the quality and safety of clinical care and quality of service activities scheduled, including all QI collaborative activities with departments such as, but not limited to: Behavioral Health and Wellness, Utilization Management, Complex Case Management.
  • Yearly objectives and planned activities, time frames for achieving, and those responsible
  • Monitoring of previously identified issues

2016-2017 SFY Medicaid Choice Work Plan

Annual Evaluations:

Special Programs:

CAHPS

CAHPS is a survey (questionnaire) that asks health plan members to report their experiences with health care.  The survey was developed by the Agency for Healthcare Research and Quality (AHRQ), and has become the national standard for measuring and reporting on members’ experiences with their health plans. These surveys cover topics that are important to health plan members.  They focus on aspects of quality that consumers are best qualified to assess, such as the communication skills of providers and ease of access to health care services.

Every year, we select a random group of our health plan members to provide information about their experiences through these surveys.  The surveys are sent through the mail or conducted by telephone. All responses are anonymous, and are reviewed collectively. The insights provided by these members are very important to us.  Denver Health Medical Plan, Inc. uses them as a Quality Improvement (QI) tool to

  • Identify strengths and weaknesses in performance,
  • Determine where we need to improve, and
  • Track our progress over time.

Detailed information about CAHPS can be found on the AHRQ website at https://cahps.ahrq.gov/

2016 Interventions

DHMC Open Shopper activity will continue in 2016-2017 to evaluate the appointment making process within the ACS clinics, pharmacy, and the Specialty Appointment clinics. The scope of Open Shopper will expand to include our extended network facilities. To improve member satisfaction the QI staff has employed strategies to increase CAHPS and HEDIS scores when there is appropriate correlations. To improve CAHPS member satisfaction and HEDIS measure rates for annual well visits for adults and children, some clinics will be holding clinical hours on Saturdays. Provider education training on CAHPS and HEDIS will be developed around gaps in knowledge.

HEDIS Measure HEDIS 2014 HEDIS 2015 HEDIS 2016 GOAL

Medicaid HEDIS Rates for Denver Health Medicaid Choice

Well-child Visits in the First 15 Months of Life – 6+ visits (W15) 63.50% 2.36% 47.45% 50%
Well-child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34) 62.04% 60.06% 62.77% 65%
Adolescent Well-Care Visits (AWC) 49.88% 39.79% 38.27% 41%
Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – BMI 91.73% 93.19% 78.83% 95%
Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – Nutrition 79.32% 77.86% 77.37% 80%
Weight Assessment and Counseling for Nutrition and Physical Activity (WCC) – Physical Activity 64.48% 62.04% 63.26% 65%
HEDIS Measure HEDIS 2014 HEDIS 2015 HEDIS 2016 GOAL

Medicaid HEDIS Rates for Denver Health Medicaid Choice.

Prenatal and Postpartum Care (PPC) – Timeliness of Prenatal Care 89.29% 84.67% 81.75% 85%
Prenatal and Postpartum Care (PPC) – Postpartum Care 57.42% 60.58% 54.74% 59%
Invervention Description of Activities
Improving Well-Child Visits
Healthy Heroes Birthday Postcards Children 2-19 years of age receive a birthday card informing them to come for their annual visit. These mailings have been going out to members since January 2009.
QI team amended the Healthy Heroes Birthday cards in 2014 to include a checklist of developmental topics the provider will cover in the well-child visit as a way of engaging the member to participate in care.
School-Based Health Centers (SBHC) Gift Card Incentive Program Students between the ages of 12-19 who are enrolled in one our School Based Health Centers (SBHC) will be eligible to receive a $10 gift card to Fandango, Subway or Ross for completing their annual well-child visit at a SBHC at no cost to the member. Providers will work with QI to complete visits and increase the WCC and AWC HEDIS measures.
Baby’s First Year Incentive Program In 2013, the Marketing Department expanded additional benefits to include “Baby’s First Year” incentives. For each newborn visit completed in the first 15 months of life, members will receive an incentive.
Provider Education on HEDIS Documentation To improve medical record documentation for well-child visit and Weight Assessment and Counseling for Physical Activity and Nutrition (WCC) measures, the QI team provides ongoing provider education by giving presentations and creating toolkits on compliant documentation.
Invervention Description of Activities
Improving Perinatal Care
Prenatal Incentive Program Each month, all pregnant members receive a mailing informing them of the Denver Health Medical Plan Prenatal Incentive Program. For each prenatal visit completed at Denver Health in the program timeframes, members receive different incentives ranging from a spa kits to a new car seat.
Postpartum Incentive Program All members receive a mailing after delivery informing them of the Mom and Baby incentive program. Members who deliver at Denver Health and attend a postpartum visit receive an incentive.
Postpartum Outreach Calls Our Care Support team calls all members 3-5 days after delivery to schedule postpartum visits within the 3 to 8 week timeframe and follows up with members to ensure visit completion. The team also offers assistance with referrals and medication if needed.