Quality Improvement (QI) is improvement strategies designed to advance the quality of care for SoonerCare members through input from members, providers, collaborative work groups and other stakeholders who advise, share best practices, interventions, program services and contribute to the development of improvement projects. Improvement strategies are central to any quality strategy and must include:
- Identifying current levels of quality
- Identifying areas for improvement
- Designing interventions to achieve improvement
- Charting progress toward quality goals
The goal of OHCA’s Quality Improvement Department include the Quadruple Aim:
- Improving health outcomes for SoonerCare members
- Improving member experience
- Decreasing the cost of care per capita
- Improving provider experience
The QI department supports the Quadruple Aim by increasing operational excellence through unit-specific dashboards, robust data management, surveys, Plan Do Study Act (PDSA) improvement tool and monitoring data trends. QI continuously promotes fiscal responsibility by controlling costs and utilization management.
The Comprehensive Quality Strategy (CQS) outlines OHCA’s process for developing and maintaining a broader quality strategy to assess the quality of care that all members receive, regardless of delivery system. It defines measurable goals, emphasizes CMS core set measures, and tracks improvement while adhering to regulatory requirements. The CQS report also describes:
- OHCA’s quality improvement infrastructure
- Development of the CQS
- Continuous program quality improvement and interventions
- The state’s plan to identify, evaluate and reduce health disparities
- CQS Document - June 10, 2022
- For public comment on CQS, please email Quality@okhca.org.
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys are an opportunity for SoonerCare members to report their healthcare experience. Through email, phone or mail, a random sample of SoonerCare members answer a standardized set of questions about patient experience and access to care.
QI will utilize surveys to gain insight into the important perspective of one of SoonerCare’s vital components: the provider. Dissatisfied and burnt-out clinicians can significantly reduce health outcomes and lower member satisfaction. By understanding providers’ unique viewpoints, OHCA can improve the experience of physicians and other clinicians in the SoonerCare network. OHCA QI uses provider surveys for advanced analytics and deeper insight to more fully understand the provider experience.
The Quality Assurance (QA) team in accordance with the Centers for Medicare and Medicaid Services (CMS) regulations follows a continuous quality improvement process to ensure the health, safety and welfare of SoonerCare members. Through an ongoing process of discovery, remediation and improvement, the QA team monitors (a) level of care determinations; (b) provider qualifications; and (c) SoonerCare member health, safety and welfare.
The QI Department encourages our members and providers to provide feedback about our activities and the information we share, what is meaningful and relevant, and how we can continue to improve SoonerCare. For feedback, please email Quality@okhca.org.
If you have issues or concerns with SoonerCare or its providers, please contact the SoonerCare helpline at 800-987-7767.