The Quality Improvement (QI) Department at Johns Hopkins Health Plans is dedicated to providing Johns Hopkins Advantage MD (Advantage MD), Johns Hopkins Employer Health Programs (EHP), PPriority Partners Managed Care Organization (PPMCO), and Johns Hopkins Uniformed Services Family Health Plan (USFHP) members with high-quality health care services. The QI Department optimizes solutions for our members through monitoring, analyzing, and reporting data, and using this to create and implement strategies for improvement.

Quality Improvement Program Goals

The QI program goals are developed to align the program outcomes to meet regulatory, accreditation, and organizational needs. Given the comprehensive nature of the requirements, the QI goals are structured into four (4) member-centric dimensions:

• Member Experience Goals
• Safety of Clinical Care Goals
• Quality of Clinical Care Goals
• Quality of Service Goals

Quality Improvement Initiatives

A quality initiative is a focused action taken by the health care organization, provider, or practitioner to improve the quality of health care services, access to care, and member health outcomes. QI initiatives are identified through analysis of data which include, but are not limited to, the following areas:

• Results of HEDIS measures
• Member Satisfaction Survey results (CAHPS^®)
• Quality of Care (QoC) reviews
• Provider Satisfaction Survey results
• Utilization Management data
• Pharmacy and medical claims data
• Member complaint data
• Provider quality performance data
• Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator data (provider-level)
• CMS Hospital Compare website data
• Health Outcomes Survey
• Population Health Incentive Program (PHIP) Measures

Multiple factors are considered during initiative development, including the prospective impact to members and the likelihood that measurable improvement will occur. Analysis of member quality and safety data is used to identify potential quality issues from individual providers, groups or facilities and may result in the initiation of clinical quality studies.

Annual Evaluations

Standard measures of clinical quality and customer experience allow individuals to compare health plans and make informed choices when it comes to the right health plan provider for themselves and their families. Two key measure sets are the Healthcare Effectiveness Data and Information Set (HEDIS^®) and Consumer Assessment of Healthcare Providers and Systems (CAHPS^®). The National Committee for Quality Assurance (NCQA), the leading authority on health plan quality, issues annual ratings for commercial health plans based on HEDIS^® performance and CAHPS^® scores.

USFHP

"Excellent Accreditation" status in 2020 through the National Committee for Quality Assurance (NCQA^®)

EHP

"Commendable Accreditation" status in 2020 through the NCQA^®

PPMCO

"Commendable Accreditation" status in 2020 through the NCQA^®

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