Quality Improvement Strategy
Devoted Health is committed to improving healthcare quality and safety and to ensuring that our members have access to the healthcare services they need. The goals of our Quality Improvement Strategy are to:
- Make sure our members get the healthcare they need and deserve
- Continuously evaluate and work to improve healthcare quality, safety, and access for our members
- Always follow all applicable laws and regulations relevant to our efforts to improve the quality and safety of healthcare for our members
We’ll accomplish these goals in several ways, including:
- Monitoring and measuring the quality, safety, and accessibility of the healthcare our members get
- Working closely with providers and other healthcare professionals to improve the quality of healthcare
- Offering evidence-based case and disease management services to our members
- Supporting our members and their doctors with the information they need to make the best possible decisions
- Continuously evaluating and updating our policies and procedures to align with the latest standards for clinical practice
Quality Improvement Activities
We use several strategies to improve the quality, safety, and accessibility of healthcare that our members get through both their medical (Part C) and drug (Part D) benefits.
We monitor and evaluate:
- The quality of clinical services our members get
- The types of services our members get — to ensure they get appropriate services for their specific medical conditions
- How satisfied members are with their healthcare — so we can identify ways to better serve them
- How well our network providers coordinate our members’ healthcare
- Overuse and underuse of certain healthcare services
- Member use of preventive care services — to ensure they get the right kinds of care
- Assess the availability and accessibility of the providers in our networks
- Credential and re-credential all providers in our networks
- Search for and work tirelessly to eliminate racial and ethnic disparities in both quality of healthcare services and access to these services
- Meet regularly with our providers to evaluate their satisfaction with our performance and to understand how we can better serve them
Meeting Our Quality Improvement Goals
Each year we take steps in several areas to achieve our quality improvement goals.
We collect Healthcare Effectiveness Data and Information Set (HEDIS®) details. HEDIS includes a broad array of clinical performance measures that help us examine the quality of care our members get for common chronic diseases like diabetes, hypertension, rheumatoid arthritis, and high cholesterol.
We scrutinize HEDIS data very closely over the course of the year to identify areas where we think our members could be getting better care. And we share these data with the Centers for Medicare and Medicaid Services (CMS). We also use these measures to set performance goals for future years.
We leverage our world-class data science capabilities to analyze clinical and claims data. This helps us generate new insights into the major drivers of healthcare quality and outcomes for our members. Once we understand these drivers, we develop interventions to help improve quality and access to healthcare for our members.
Case and Disease Management
We support our members and our provider partners with case and disease management activities like:
- Helping hospitalized members safely and securely transition back into the community, without needing to be readmitted to the hospital
- Working with members to help them effectively manage common chronic diseases like high blood pressure and diabetes
- Connecting members with community resources to help them better manage the key social determinants of health that may impact their ability to care for themselves and access the right healthcare services
Quality Improvement Programs for Medications
We have a set of quality improvement programs and strategies focused on improving appropriate medication use, like:
- Medication-related safety and monitoring solutions that target high-risk non-opioid drug classes, preventing polypharmacy and inappropriate use and abuse of opioids and other controlled substances
- Monitoring opioid use so we can identify and work to mitigate opioid misuse and abuse
- Monitoring and improving adherence with highly effective medications, including oral diabetes medications, cholesterol-lowering medications, and blood pressure-lowering medications
- Reconciling members’ medications after they go home from a hospital or post-acute care facility — helping to prevent medication-related errors and adverse events