Quality improvement programs

Being better is in our bones. That means we're always looking for ways to measure and, where needed, improve the quality of our healthcare services.

Our quality improvement initiatives do just that. Through these efforts, we enhance member health and care experiences and reduce internal cost. Together, we create better outcomes for everybody we touch.

How we assess and ensure quality

Our Healthcare Services programs support members at all stages of life and health. To measure our impact, we use results from the Healthcare Effectiveness Data and Information Set (HEDIS®)* and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Depending upon state and medical plan type, we annually evaluate HEDIS and CAHPS results to determine what areas our improvement activities should be focused on. We also review our medical and pharmacy claims data to ensure we:

To get a better feel for what we do, see the list of our quality improvement projects below. We regularly check our progress by monitoring our HEDIS results and analyzing our medical and pharmacy claims.

Health coaching services

Our health coaching program guides members through chronic condition management so they feel their best. Participants receive one-on-one support from one of our health coaches by phone or email. Together, they design a plan of action and track progress toward better health. Along the way members win incentives, as well as advice and information whenever they need it.

Health coaches send reminder mailings, worksheets, workbooks and online support tools to keep members engaged. For example, participants with diabetes learn why regular eye exams and hemoglobin A1c testing are so important. They also get tips on taking medications, such as those for high blood pressure, correctly.

Any Moda Health member can enroll in one of nine care programs:

Measuring health coaching success

We use data from member surveys and clinical outcomes to measure the success of our health coaching. Survey results were positive, with 94.45 percent of all participants agreeing or strongly agreeing with all of the positively framed survey statements. Our goal is to receive "very good" or "excellent" responses from at least 95 percent of respondents. Clinical outcomes were also better for members who engaged in health coaching than for those who did not participate.

Learn more about our healthcare services.

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Diabetes screening reminders

We understand that our members have busy lives and sometimes forget to put their health first. That's why we send reminder letters to our members who have diabetes. We do this to help them receive better preventive screenings and services. Our goal is to increase LDL-C screenings, dilated eye exams, hemoglobin A1c screenings and nephropathy screenings.

Our reminders go out monthly. They explain why screenings are important, how often to have them and what they entail. Members receive a dental cleaning reminder if they did not have a cleaning in the past year.

In addition, we send medication mailings that include information about drugs for high blood pressure and how to protect kidneys.

All along, we keep providers up to date about members' care by sharing information about their needs for screenings and medications.

Measuring diabetes screening reminders success

Our goal is to meet or exceed the HEDIS national and regional means for this measure.

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Adult health screening reminders

Everyone needs regular screenings, but it's hard to keep track. We created a reminder card about important age- and gender-specific preventive screenings. These reminders encourage our members to receive cervical cancer, breast cancer, colorectal cancer and other important screenings.

Measuring adult health screening reminders success

Our goal is to meet or exceed the HEDIS national and regional means for this measure.

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Medication adherence

We want more of our members to correctly take their medications for depression, cardiac health and asthma. To help, we send them information that explains why it's important to take medications as directed. We send their providers copies of member materials, adherence information and a letter encouraging them to discuss medication adherence with their patients. Along with our materials, we tell members about Moda Health care programs and other ways we can support them.

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Childhood immunization reminders

A healthy child makes for a happy family. We send a newsletter to parents of five-month-old children to educate them about vaccines. We explain why immunizations are important, talk about the risks of not immunizing, and debunk common myths. We also include daycare and school exclusion dates.

Measuring childhood immunization reminders success

Our goal is to meet or exceed the HEDIS national and regional means for this measure.

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Flu and pneumonia vaccine reminders

We send all Moda Health medical members a flu vaccine reminder. We also promote an annual flu shot and the once-in-a-lifetime pneumonia vaccine online, within myModa. Our goal is to increase the rate of flu and pneumonia vaccinations among our members.

Measuring pneumonia vaccine reminders success

Our goal is to meet or exceed the CAHPS national and regional means for this measure.

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Tobacco cessation program

Quit For Life is a Moda Health program that helps members quit using tobacco. This program is free to all eligible members** and offers the following:

The Quit for Life program can help members quit tobacco for good. For more details, call 866-784-8454 or visit quitnow.net.

For members not eligible for Quit for Life, Moda Health promotes the Oregon Quit Line and National Quit Line. Each of these includes the following resources:

Measuring tobacco cessation program success

We send a monthly mailing to members identified as tobacco users. Members are referred to the tobacco cessation program through mailings, provider referrals and health coach referrals. Our goal is to increase enrollment in the program and decrease the use of tobacco.

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Oral health communications

We encourage good oral health in a number of ways. While oral health is important for everyone, it's especially important for pregnant women, children and diabetics. Our goal is to increase dental cleanings by 5 percent annually. We send educational materials to members about the importance of oral hygiene during pregnancy. For Medicaid members, we provide materials in both English and Spanish.

It's easy to lose track of regular cleanings, so we send reminders to members who have not had a dental cleaning in the past year. Parents or caregivers of children six months to 17 years old with the OHP dental benefit receive an English or Spanish brochure about oral health for children. The brochure offers tips on good oral hygiene and a timeline for dental care for babies.

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Health equity initiative

Everyone deserves high-quality healthcare, no matter where they come from. We designed this initiative to eliminate health disparities, providing the highest quality of care for all members.

Today, we have four major initiatives:

We've built a presence at local and state-wide health equity events, and have joined national programs that address racial and ethnic disparities. We participate in the Health Literacy Task Force, facilitated by America's Health Insurance Plans, which encourages the development of health literacy programs. A workgroup of our managers, directors and vice presidents from 18 different Moda Health departments meets on a quarterly basis to discuss our health equity efforts.

We are getting to know our members in a new way by understanding who they are. For the big picture, we've analyzed state-level data on racial and ethnic diversity. To understand who we serve, we have begun to collect and analyze the race, ethnicity and language data of our members. In our analysis, we look at specific chronic conditions to identify and correct disparities. We're also working with the Oregon Health Authority to improve the way we collect data for Oregon Medicaid members.

We're working on how we communicate with members. Our policy for cultural competency and plain language raises the bar for all member materials. We're building a staff cultural competency training program and going beyond phone translation to provide even better services to speakers of other languages.

Today, we're making progress as we get ready to implement our Cultural Competency and Health Literacy policy. We'll continue to learn more about our members' diverse backgrounds and participate in local, state and national partnerships that advance health equity.

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

**Not all Moda Health members are eligible for Quit For Life benefits.

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

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