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Quality Improvement Performance

The West Virginia Senior Advantage Quality Improvement Program (QI Program) is developed annually along with the Quality Improvement Workplan (QI Workplan).

The QI Program: The Quality Improvement Program Description (QI Program) describes care coordination and collaborative initiatives implemented to provide services necessary to meet the needs of its members. The QI Program defines key activities conducted by the health plan to continuously improve service as well as medical and behavioral health outcomes.

Program Goals and Objectives:
The primary goal of the QI Program is to impact and sustain improvement in member health outcomes. The QI Program establishes goals and objectives that encompass the QI activities across the market. The 2021 goals and objectives align to the following areas:

  • 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 QI Program goals align with the QI activities listed on the QI Workplan.

The QI Workplan: The QI Workplan identifies planned activities related to QI Program priorities that address quality, clinical care and services.  Action steps include target dates for completion and identification of responsible oversight committees.  Monitoring of activities includes tracking and trending of identified issues and planned interventions. The QI Workplan is developed annually and approved, with input, by the Quality Improvement Committee and Board of Directors.

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

  • Access and Accessibility
  • Coordination of Care and Appropriate Service Delivery
  • Enhancing Care Transitions
  • Appropriate Service and Utilization for Preventive Health and Chronic Conditions

2020 Quality Program Evaluation Summary results:

  • Quality Program Objectives Met (Goals)
  • Health Risk Assessment Reporting
  • Electronic Medical Record enhancements to meet quality, regulatory and compliance objectives
  • Successful completion of Data Validation Audit
      • The plan was not eligible for a Part C Summary or Overall 2021 Star Rating. However, the plan did receive a Part D Summary Rating of 4 Stars out of five (5) Stars for 2021 Star Ratings. Please visit https://www.medicare.gov for more information on Star Ratings.
      • The plan achieved 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 – Functional Status Assessment-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
      • Completed the CMS attestation for the annual Chronic Care Improvement Program (CCIP) update
      • Model of Care training provided to health plan and vendor staff
      • Model of Care training made available to providers via West Virginia Senior Advantage website
      • Model of Care goals measured and reviewed during Quality Improvement Committee as planned

Challenges/Opportunities:

  • COVID-19
  • Reporting challenges
  • Ongoing education to staff regarding clinical model, transition of care process and documentation processes
  • Educating key resources in facilities