Employer-Sponsored Health Plan: Quality Evaluation
Health Partners is actively involved in quality improvement and cost reduction initiatives with an employer-sponsored health plan. A robust data repository containing claims information and other data is being used to measure and affect quality and cost trends for this health plan's population. The goals are to assist the health plan's members in successfully navigating the healthcare environment, to improve their health, and to assist in reducing the cost of care.
Health Partners measured quality performance for selected medical conditions among 18 primary care provider groups that include more than 250 physicians and represent 45% of Health Partners' total primary care membership.
These provider groups received reports on key processes and utilization measures that were developed using the health plan's database. The reports showed that these groups' performance compared to both Health Partners' primary care physician membership as a whole and to a national database. The time period for evaluation was July 1, 2007, to June 30, 2008. The measures were chosen because of their similarities to HEDIS measures and their importance to other quality care standards.
Health Partners' program objective was to provide physicians with transparent data that provider groups can use to evaluate their performance compared to national and local benchmarks. This comparison gives the provider groups the ability to evaluate their practice's quality and cost performance and make necessary performance improvement.
The impact of measuring the Health Partners primary care physicians and provider groups against national standards identified clinical areas in need of improvement. In many cases, individual physicians and practices are not aware of their performance in key clinical areas. These reports provide an evaluation tool for quality improvement.
Please see the complete Employer-Sponsored Health Plan Quality Evaluation Report for more specific details of this program.