QM Program Objectives

Quality Management (QM) Program Goals and Objectives
The goals and objectives of the QM Program are: To improve the quality of medical and behavioral health care and service provided to Members through administrative simplification and a comprehensive and ongoing system of monitoring measurable performance indicators (including indicators based on high-volume, high-risk, and problem-prone services, data from customer satisfaction surveys, complaints/occurrences, and appeals, and other relevant sources), evaluating results relative to established goals and benchmarks, and acting to promote improvement To maintain a process for adopting and updating both preventive health guidelines and nonpreventive (i.e. acute and chronic) clinical practice
– including language in practitioner/provider contracts requiring participation in the QM Program and access to medical records. To promote communication with practitioners/providers of care/service about quality activities, providing feedback on results of plan-wide and practice-specific performance assessments, and collaboratively developing improvement plans To disseminate information on practitioner/provider performance to promote Member empowerment and informed decision making To ensure that the quality of care and service delivered by delegates meet standards established by us and relevant regulatory agencies, and that delegates maintain continuous, appropriate, and effective quality improvement programs through ongoing oversight activities and regular performance assessments To document and report the results of monitoring activities, barrier analyses, recommendations for improvement activities, and other program activities to the appropriate committees To comply with all regulatory requirements, to achieve and maintain accreditation, and necessary certification To ensure that the
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Keystone Health Plan East HEDIS Effectiveness of Care Measures
2005 (Reporting Year 2004) 2006 (Reporting Year 2005) 2007 (Reporting Year 2006)

Antidepressant Medication Management Optimal Effective Acute Continuation Phase Adolescent Immunization Combo 2 (MMR, Hep B, VZV)received the 2nd MMR, 3
Hepatitis B vaccinations; and on VZV prior to 13th birthday

20.18% 56.45% 40.59% 66.20% 57.23% 94.27% 96.92% 69.67% 77.47%

24.64% 54.77% 37.68% 70.02% 62.17% 98.36% 100.00% 70.57% 78.75% 83.33%

16.47% 55.03% 29.93% 81.36% 69.70% 97.62% 99.29% 66.07% 77.18% 82.48% 38.80% 42.86% 41.02% 90.11% 63.82% 53.59% 60.97% 89.61% 27.25% 86.84% 49.42% 81.99% 65.10% 78.77% 61.59% 86.96%