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Best Practices for Health Maintenance Organizations and Provider Service Networks

Join Yolanda Strozier, MBA, as she presents key strategies for enhancing outreach effectiveness in health maintenance organizations (HMOs) and provider service networks (PSNs). This session covers establishing specific goals with measurable progress metrics, illustrated by examples of successful outreach for postpartum visits. Learn from Florida's high performers who have exceeded national HEDIS benchmarks in various health metrics. Discover available resources for best practices, case studies, and tools to improve health care delivery and quality.

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Best Practices for Health Maintenance Organizations and Provider Service Networks

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Presentation Transcript

  1. Breakout Session #1 Shared Best Practices HMOs/PSNs Yolanda Strozier MBA Project Manager, EQRO Services

  2. Identify the Goal • Written statement • Be specific • Use numeric values • Be realistic but still make it a stretch

  3. Establish a Method to Measure Progress Example of Measurement of Improvement: Numerator: • Number of successful outreach attempts to members who are due for a postpartum visit Denominator: • Total number of members who are due for a postpartum visit

  4. Examples of High Performers The following Florida Plansmet or exceeded national HEDIS benchmarks (High Performance Levels): • Staywell (Reform)- Well Child Visits 3 to 6 Years • Humana (Non-Reform) & Preferred (Reform) - Diabetes, LDL-C Screening • SFCCN (Non-Reform) - Diabetes, Nephropathy • Vista SF (Reform) - Diabetes, Good HbA1c Control • Citrus (Non-Reform) & Preferred (Reform)- Controlling High Blood Pressure

  5. Examples of High Performers Examples of successful intervention strategies presented by Florida’s high performers Open discussion and brainstorming

  6. Available Resources • http://www.chcs.org provides toolkits, case studies, sample materials, and other resources • http://www.qualityprofiles.org provides a variety of case studies and tools for most HEDIS measures • http://www.ihi.org/ihi provides improvement strategies, resources, and educational opportunities

  7. Available Resources • http:// www. mahp.org/events/pinnacles/08pinnaclebook.pdf provides examples of best practices among Michigan health plans • http:// www.innovations.ahrq.govPromotes exchange of information and dissemination of health care service delivery innovations and quality tools. It also includes attempts, along with level of evidence (strong, moderate, low, insufficient).

  8. THANK YOU FOR YOUR PARTICIPATION!

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