BadgerCare Plus & Medicaid SSI Provider Manual - Group Health ...

BadgerCare Plus & Medicaid SSI Provider Manual - GHC of Eau Claire May 2012
SECTION 3 - QUALITY IMPROVEMENT
Quality Improvement is an integrated process throughout the GHC organization. The Mission Statement for the
GHC Quality Improvement program is:
“To objectively and systematically identify opportunities for improvement and to continuously assess the
effect of improvement activities in order to meet or exceed internal and external customer expectations.”
This statement provides specific direction regarding the focus of quality improvement for GHC. In order to satisfy
the goals of this mission statement, we feel that all GHC providers and facilities must collaborate with and
embrace the activities of quality improvement. Such activities include satisfaction surveys, population and random
sample based studies, and participation in multi-disciplinary teams for problem solving. These activities allow the
organization to continuously improve upon processes of healthcare delivery in order to ensure that we are
providing our members with highest quality of care in a cost-effective manner.
Activities of quality improvement programs in HMOs are critically reviewed by organizations such as the
Accreditation Association for Ambulatory Healthcare, Inc. (AAAHC) or National Committee for Quality Assurance
(NCQA). We recognize that the consumer demands that organizations such as ours are held accountable for the
services that are provided. Accreditation by organizations such as AAAHC or NCQA provides the consumer with
assurances that the HMO has appropriate quality improvement structures in place and that those activities have a
positive impact on healthcare delivery.
In addition, the Wisconsin BadgerCare Plus/Medicaid SSI Managed Care Program requires that participating
HMOs have effective quality improvement structures in place. As part of the State of Wisconsin BadgerCare
Plus/Medicaid SSI program and HMO relationship, HMOs are required to provide the state with accurate
encounter data within specified time frames. This data is collated and reported annually by the State of
Wisconsin. Indicator data is reported in the following areas: Women's Healthcare; Child Healthcare; Acute and
Chronic Condition; Mental Health; Preventive Care and Other Healthcare. Using this information, we are able to
identify areas for improvement in serving these populations. The healthcare Provider's role in supplying this data
is extremely important! With accurate information, we are able to provide better administrative support for our
Plan Providers.
Information from quality improvement activities is actively shared with our providers and staff. We encourage
constructive feedback and are available as a resource for quality improvement activities of GHC providers and
facilities. Questions or requests for information should be directed to the Quality Improvement Manager at the
Administrative Offices at PO Box 3217, 2503 N. Hillcrest Parkway, Eau Claire WI 54702, 715-552-4300, or toll
free 1-888-203-7770.
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