West Virginia Senior Advantage Quality

West Virginia Senior Advantage (HMO SNP) is designed to meet the needs of our members and health care partners with the highest quality and safety standards. Our health plan adheres to the Centers for Medicare & Medicaid Services requirements and standards set forth by  the National Committee for Quality Assurance (NCQA).

The West Virginia Senior Advantage Quality Improvement (QI) Department has a mission to provide an effective, system-wide, measurable plan for monitoring, evaluating and improving the quality of care and services in a cost-effective and efficient manner to our enrolled members and contracted providers.

  • West Virginia Senior Advantage’s mission, vision, and core values create the foundation for organizational QI.
  • West Virginia Senior Advantage uses quality assurance and performance improvement to make decisions and guide our day-to-day operations.
  • West Virginia Senior Advantage’s QI Program includes all business lines, partners, departments and services.
  • West Virginia Senior Advantage’s QI Program is comprehensive and inclusive of model of care, management practices, and business practices.
  • West Virginia Senior Advantage’s QI Program is data-driven and supports the plan’s mission, vision, and values through continuous improvement and monitoring of medical care, patient safety, and the delivery of services to members.
  • West Virginia Senior Advantage’s QI Program decisions are based on data, which is collected in a systematic format in alignment with our infrastructure.

Quality Objectives

  • Improve the quality of clinical care and service
  • Improve member’s experience
  • Promote access and availability to affordable health care
  • Adhere to regulatory requirements

The Quality Improvement Program (QI Program) and the Quality Improvement Workplan (QI Workplan) are developed annually.

The QI Program describes the steps the health plan takes to manage member care. This includes:

  • How the plan provides services that the member may need to stay healthy
  • Key activities put in place by the health plan to continuously improve service and the member’s overall health results

QI Program Goals and Purpose The most important goal is to improve members’ health. The program sets goals that includes different activities in the health plan’s service area. The 2022 goals include the following areas:

  • Member experience
  • Access to affordable health care
  • Quality of care and service for members
  • Centers for Medicare and Medicaid Services (CMS) requirements

The QI Workplan: Annually, leaders within the health plan collaborate to develop the QI Workplan. The QI Workplan identifies activities related to the goals of the QI Program. These activities relate to quality member care and services.  Each activity has a goal date for completion and who within the health plan is accountable for that area. There is also a review of activities, which includes tracking any issues and deciding how to solve them quickly and effectively.

Model of Care:
The Model of Care goals are focused on 4 key areas:

  1. Helping care coordination and quality of service
  2. Assisting members who experience a change in care
  3. Ensuring members have access and accessibility to health care
  4. Giving members the appropriate resources to prevent health issues and treat chronic health care problems

2021 Quality Program Evaluation Summary results:

  • Quality Program Goals that were met in 2021:
    • The plan did not receive a Part C summary rating, but did receive a Part D summary rating of 4.5 Stars. The Plan did not receive an overall Star rating. Please visit https://www.medicare.gov for more information on Star Ratings.
    • The plan received 5 out of five (5) Stars on the following 2021 Star Rating measures:
      • Special Needs Plan (SNP Care Management) –5 Stars out of five (5) Stars
      • Care for Older Adults – Medication Review- 5 Stars out of five (5) Stars
      • Care for Older Adults – Pain Assessment- 5 Stars out of five (5) Stars
      • Statin Use in Persons with Diabetes (SUPD)- 5 Stars out of five (5) Stars
      • MPF Price Accuracy-5 Stars out of five (5) Stars
      • Medication Adherence for Diabetes Medications- 5 Stars out of five (5) Stars
      • Medication Adherence for Hypertension (RAS antagonists- 5 Stars out of five (5) Stars
      • Medication Adherence for Cholesterol (Statins)- 5 Stars out of five (5) Stars
    • Reporting member’s Health Assessment completion to CMS
    • Electronic Medical Record improvement to meet quality goals
    • Completed required CMS activities
    • Model of Care training was given to health plan staff
    • Model of Care training made available to providers on the health plan website
    • Model of Care goals measured and reviewed by health plan leaders
  • Challenges:
    • COVID-19
    • Challenges with reports
  • Opportunities:
    • Continuing education to staff about the clinical model and care coordination
    • Providing education to skilled nursing facilities where members live

West Virginia Senior Advantage Quality Program

For more information about the West Virginia Senior Advantage Quality program, please call Member Services at 1-844-854-6888 (TTY 711). Calls to this number are free.

Our hours are 8 a.m. to 8 p.m., seven days a week (except Thanksgiving and Christmas) from October 1 through March 31, and Monday to Friday (except holidays) from April 1 through September 30.

Want more information about West Virginia Senior Advantage?

Call us at 1-844-854-6888 or TTY 711.
Our trained member service representatives are available from 8:00 a.m. to 8:00 p.m.