Quality


Accreditations

AlohaCare’s commitment to quality and accountability was recognized when our AlohaCare plan for QUEST Integration members was awarded Health Plan Accreditation from NCQA. AlohaCare was measured against national standards and underwent a rigorous evaluation to earn the award. The NCQA accreditation process demonstrates a commitment to quality services and serves as a framework to improve business processes through benchmarking organizations against nationally recognized standards.

The National Committee for Quality Assurance (NCQA) is a not-for-profit organization dedicated to improving health care quality. NCQA has been driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda. It provides a symbol of excellence that is a reliable indicator that an organization is well-managed and delivers high quality care and service. NCQA Accreditation Seal

 


Clinical Practice Guidelines

AlohaCare uses evidence-based clinical practice guidelines developed by local and national associations. With the assistance of local physicians serving on our Medical and Behavioral Health Advisory Committees, the following guidelines have been adopted as minimum standards for AlohaCare providers.
 
  1. Adult Preventive Health (Adopted: 12/2/02, recently revised: 2/27/17)
  2. Management of Chronic Heart Failure (Adopted: 9/7/07, recently revised: 2/12/18)
  3. Chlamydia (Adopted: 8/19/11, recently revised: 2/12/18)
  4. Coronary Artery Disease (CAD) (Adopted: 11/16/12, recently revised: 10/6/17)
  5. Adult Immunizations (Adopted: 5/21/10, recently revised: 2/12/18)
  6. Child/Adolescent Immunizations (Adopted: 5/21/10, recently revised: 2/12/18)
  7. Diabetes Mellitus (Adopted: 12/20/02, recently revised: 10/6/17)
  8. Diagnosis and Treatment Management of Attention Deficit/Hyperactivity Disorder (ADHD) in School-Aged Children (Adopted: 5/21/10, recently revised: 10/6/2017)
  9. Management of Asthma (Adopted: 12/20/02, recently revised: 10/6/17)
  10. Routine Prenatal and Postpartum Care (Adopted: 12/20/02, recently revised: 2/27/17)
  11. Treatment for Patients with Major Depressive Disorder (Adopted: 3/21/03, recently revised: 10/6/17) 
  12. COPD (Chronic Obstructive Pulmonary Disease) (Adopted: 10/6/17)
  13. Hypertension (Adopted: 6/22/18)
  14. Chronic Kidney Disease (CKD) (Adopted: 10/6/17)

Quality Improvement Program Hedis

“HEDIS” is an acronym for the Healthcare Effectiveness Data and Information Set, which is a set of standardized measures designed by the National Committee for Quality Assurance (NCQA) to evaluate the performance of health plans. It allows for the assessment of health plans on the basis of quality and performance. Since its introduction in 1993, HEDIS has evolved to become the “gold standard” in managed care performance measurement.

AlohaCare is required to report the results of several HEDIS indicators annually to our State regulators, the Hawaii Department of Human Services (DHS), and our Federal regulators, the Center for Medicaid and Medicare Services (CMS). By measuring HEDIS indicators annually, we are able to evaluate our performance achievements, monitor our quality improvement efforts, and identify further opportunities for improvement in our health care delivery efforts.

2018 HEDIS Hybrid Measures Education Tool

AlohaCare’s Quality Improvement Program is built on a foundation of dedication to high quality collaborative relationships with providers, practitioners, members, and commitment to continuous improvement in effective, efficient and timely care and service. AlohaCare’s commitment to continuous improvement in care and services is the underpinning for the quality improvement program.

Goals

AlohaCare’s primary quality improvement goal is to improve members’ health status through a variety of activities implemented across all care settings and aimed at improving quality of care delivered and quality of services provided while promoting safe clinical practices.

Scope

The scope of AlohaCare’s quality improvement program is comprehensive and encompasses all clinical care and service aspects ces

  • Availability of services
  • Behavioral Health Services
  • Clinical quality improvement
  • Service quality improvement
  • Member experience
  • Practitioner experience
  • Clinical practice guidelines
  • Preventive health guidelines
  • Continuity and coordination of care
  • Patient safety
  • Practitioner performance
  • Effectiveness of the quality improvement program

Methods and Measures

AlohaCare’s Quality Improvement Program relies on both external and internal processes to measure quality. Outside organizations, such as NCQA, Medicare, HSAG and other agencies are measuring our performance based on National Standards, such as HEDIS, CAHPS, EQRO surveys and NCQA accreditation. Internally, we remain focused on providing superior service to our members, providers and other external partners. Our goal is to be viewed as the best MCO in Hawaii. We measure our success by reviewing and addressing complaints, grievances, quality of care reviews and appeals of our prior authorizations. We welcome comments on our performance in meeting all our Quality goals.   Please send any comments to Performance Improvement Department at PerformanceImprovement@alohacare.org.

AlohaCare’s Quality Improvement Incentive Program is available to all primary care providers who serve as PCP for at least one member eligible for incentivized services. In the spring, a program packet is mailed which includes a cover letter, a member-level list for each incentive measure, a measure education worksheet, and a participation acknowledgement form.

 

For our Quest members, the program incentizes some of the key HEDIS measures, although the details may vary each year slightly depending on both AlohaCare’s focus and the State’s focus. Example of measures would be:

 

  • Childhood Immunization (Combo 2)
  • Frequency of Prenatal Care
  • Timeliness of Prenatal Care
  • Controlling High Blood Pressure
  • Comprehensive Diabetes Care (four components)

 

This incentive program will be updated yearly. Incentive payments to providers may be based on incentive/member or a more global amount measuring how close the total membership in that practice come to meet the State’s goals .

 

For our PCP who provide primary care for our Medicare members, a similar incentive plan exists, based on slightly different measures. 

Provider Report Cards will be distributed on a regular basis.

 

Questions about this quality incentive program can be directed to: PeformanceImprovement@alohacare.org