Effectiveness of 2015 Moda Health Quality Improvement Program

At Moda Health, we take quality seriously. Each year we identify ways to improve what we do for our members, practitioners and clients. Our goal? To offer the most cost-effective and highest-quality services to our communities. Based on our 2015 quarterly updates, we are well on our way to completing most of our work plan. Read on to see how.

Annual work plan

We often encourage our members to put their goals in writing. That's how we do it, too. We wrote an inter–departmental work plan that highlighted our quality initiative goals for 2015 and reported back to our Medical Quality Improvement Committee (MQIC). It took a lot of work from a lot of people, but we finished most of what we set out to do. There were a few snags — competing priorities, transitioning staff and reassessment of needs — that delayed or discontinued a few remaining items in our work plan. But we're proud of the progress we made.

Annual member survey

We always want to make sure our member experience is better than ever. So we launched a member survey workgroup, bringing together people who work across all departments of Moda Health. They measured our Oregon, Washington and Alaska group and individual member experience with many different aspects of product offerings, including medical, pharmacy, behavioral health, utilization management, access to care, and health information line services.

Patient Safety Committee

Nothing is more important to us than our members' health and safety. Our Patient Safety Committee works across departments to promote activities that improve patient and clinical safety. The committee includes our medical directors and representatives from Behavioral Health Services, Case Management, Health Promotion and Wellness, Medical Contracting, Pharmacy Services and Quality Programs. Here's a summary of our committee's goals:

Patient safety initiatives

We set goals to better understand and improve patient and clinical safety. Here's what we worked on across Moda Health:

HEDIS initiatives

We use the Healthcare Effectiveness Data and Information Set (HEDIS®)* — a series of health plan industry measures — to see how well we are taking care of members. Our HEDIS "Tiger Team" worked throughout the year on programs that improve our HEDIS scores. But, more importantly, these programs improve how we deliver care to our members. These programs include working with Pharmacy Customer Service to make sure that members who have been prescribed new medications receive follow-up care to monitor side effects and take their medications safely. They also include follow up with members after heart attacks and mental health hospitalizations to ensure they are getting the right care. We also work to identify and correct the root causes of data issues to help improve our HEDIS scores on an ongoing basis.

CAHPS initiatives

Each year we send out the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. It asks members to rate their experience with our healthcare services, providers and benefits. The survey shows us how we can improve and better serve our members. In 2014, we created new CAHPS initiatives to address these areas for improvement, and in 2016 we will continue to:

Quality summary

We promise to keep throwing ourselves into our work. We'll continue to dedicate our energy and resources so we can improve quality – and demonstrate the best that a health plan can do across Oregon, Washington and Alaska. Our commitment to quality is not just a source of pride. We believe it's also a differentiator in the marketplace. In everything we do, we strive to reach the Triple Aim: Improve the health of the population; enhance the patient experience of care (including quality, access and reliability); and reduce the cost of care.

*HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).

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Hello.

We have exciting news to share. ODS is changing its name to Moda Health.

Moda comes from the latin term "modus" and means "a way". We picked it because that's what we are here to do: help our communities find a way to better health.

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