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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 receive 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 healthcare used by our members
  • Working closely with providers and other healthcare professionals to improve the quality of healthcare
  • Offering our members access to evidence-based case and disease management services
  • 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 receive through both their medical (Part C) and drug (Part D) benefits.

We monitor and evaluate:

  • The quality of clinical services our members receive
  • The types of services our members receive, so we can ensure they get appropriate services for their specific medical conditions
  • Member satisfaction with their healthcare and ways we can better serve them
  • How well our network providers coordinate member healthcare
  • Overuse and underuse of certain healthcare services
  • Member use of preventive care services, so we can ensure they receive the right kinds of care

We also:

  • Assess the availability and accessibility of the providers in our networks
  • Credential and recredential 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

We plan to take steps in several areas to achieve our quality improvement goals.

Clinical Data
We’ll 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 receive for common chronic diseases like diabetes, hypertension, rheumatoid arthritis, and high cholesterol.  

We’ll 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 Center for Medicare and Medicaid Services (CMS). We also use these measures to set performance goals for future years.

Data Science
We’ll 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’ll develop interventions to help improve quality and access to healthcare for our members.

Case and Disease Management
We’ll assist members and our provider partners with several case and disease management activities, such as:

  • 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 such as hypertension and diabetes
  • Accessing community resources to help members 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’ll implement a set of quality improvement programs focused on improving appropriate medication use, such as:

  • Medication-related safety and monitoring solutions that target non-opioid, high-risk drug classes. These solutions focus on preventing polypharmacy and inappropriate use and abuse of controlled substances, including opioids.
  • Targeted strategies for monitoring opioid use with the goals of identifying and working to mitigate any cases of opioid misuse and abuse.
  • A program focused on monitoring and improving adherence with highly effective medications, including oral diabetes medications, cholesterol lowering medications, and blood pressure lowering medications.
  • Reconciliation of members’ medications after they’re discharged home from the hospital or a post-acute care facility. The goals is to help prevent medication-related errors and adverse events.