Sharp Health Plan Quality Improvement Program
Sharp Health Plan is part of the integrated Sharp HealthCare system, a recipient of the 2007 Malcolm Baldrige National Quality Award. At the forefront of Sharp’s commitment to excellence is The Sharp Experience, a sweeping performance improvement initiative launched in 2001. This initiative has resulted in numerous advances in clinical outcomes, patient safety enhancements and organizational and service improvements.
Quality improvement program goals and outcomes
Sharp Health Plan's Quality Improvement (QI) Program goals are to offer quality care and services that set community standards, fulfill members’ expectations, and ensure that medical services are provided in a caring, effective, cost efficient and accessible manner.
Sharp Health Plan performs annual reviews of indicators for clinical care and member satisfaction using industry standard measures and surveys. The most recent results show improvements from 2009 to 2010 in colon cancer screening and how well people with heart disease take their medications. Member satisfaction rates also improved overall from 2009 to 2010.
Sharp Health Plan is preparing to undergo National Committee for Quality Assurance (NCQA) accreditation surveys for Wellness and Health Promotion in 2012 and a full health plan survey in 2013.
Quality improvement program activities
Patient Safety
Sharp Health Plan advocates a collaborative approach to foster a culture of patient safety, reduce medical errors and promote high quality care. Sharp Health Plan focuses on the monitoring of clinical performance indicators, provider credentialing, and coordination of care to ensure a safe delivery system.
Preventive health and clinical practice guidelines
Preventive health guidelines are reviewed and updated using the most current and reasonable published medical evidence and the U.S. Preventive Services Task Force recommendations. Preventive health guidelines are available here for Adults and for Pediatrics and Young Adults.
Clinical practice guidelines encompass acute and chronic care relevant to Sharp Health Plan membership. Clinical practice guidelines are available to practitioners online and in the Provider Operations Manual.
Access and Availability
Sharp Health Plan ensures health care provider compliance with the California laws and regulations regarding timely access to care. Sharp Health Plan is responsible for ensuring that the provider network is sufficient to provide accessibility, availability and continuity of covered health care services and to ensure the provision of covered services to members in a timely manner.
An annual Provider Satisfaction Survey to assess provider satisfaction with access is completed via the Industry Collaborative Effort (ICE) Provider Satisfaction with Access Survey for providers in contracted medical groups. The Provider Access Appointment Availability Survey is also completed each year. The survey is conducted using the ICE-developed survey tool for providers in contracted medical groups and by our contracted survey vendor for the independently contracted providers.
Performance measurement
Healthcare Effectiveness Data and Information Set (HEDIS®)
HEDIS is one of the most widely used set of health care performance measures in the United States. HEDIS includes 75 measures across several aspects of care including Effectiveness of Care, Access/Availability of Care, Use of Services, and Cost of Care. Results are used to identify opportunities for improvement. Quality interventions include educational initiatives for both members and providers.
Member satisfaction
Grievances and Appeals
Grievances and appeals are reviewed on a monthly basis. A grievance is an expression of dissatisfaction with Sharp Health Plan or one of our providers. An appeal is filed when a member disagrees with a decision made by Sharp Health Plan or a Plan Medical Group. Grievances and appeals are categorized by: Quality of Care, Access, Quality of Service, Billing and Financial Issues, Benefits, Quality of Practitioner Sites and Other. Sharp Health Plan completes a thorough investigation and follow-up on each case.
Consumer Assessment of Healthcare Providers and Systems (CAHPS®)
The annual CAHPS survey provides information on the health care experience of Sharp Health Plan members and on how well their expectations have been met. Survey results summarize member experiences through ratings of both the health plan and the doctors who provide care. Results are shared with Sharp Health Plan contracted providers and used to identify opportunities for improvement.
