The Quality Program (QP) supports Regence’s commitment to ongoing quality
care for our members. We have developed standards and performance goals and
continue to monitor them to identify improvement opportunities.
Participation in the Quality Program
Participation in Regence QP activities is required in our agreements with
physicians, other health care professionals and facilities. Participation may
include:
- Site visits and record review
- Adherence to clinical standards
- Credentialing or re-credentialing
- Quality of care concerns or complaints
- Providing evidence of preventive health promotion
- Providing data for various medical records audits such as the annual Healthcare
Effectiveness Data and Information Set (HEDIS®) audit
Providers may be asked to review and provide feedback on proposed or ongoing
clinical activities and development of clinical practice guidelines at focus
groups or Medical Advisory Committees.
Quality Program scope
The scope of the QP includes developing improvement opportunities and activities
throughout Regence that directly impact the experience of our members, physicians,
other health care professionals or facilities:
| 1. |
Develop focused quality improvement activities (QIAs) including: |
| |
- Clinical QIAs
- Service QIAs
|
| 2. |
Monitor activities throughout Regence to further the “integration
of our processes” including: |
| |
- Access
- Availability
- Quality surveys
- Staff qualifications
- Advance directives
- Member satisfaction
- Provider satisfaction
- Medical record keeping
- Quality of care concerns
- Community collaboration
- Under and over utilization
- Pharmacy education programs
- Disease management programs
- Coaching and wellness programs
- Clinician performance monitoring
|
| 3. |
Monitor patient safety activities to fulfill our commitment
to the safe delivery of care to our members. |
| 4. |
Support contractual and regulatory compliance. |
| 5. |
Develop and administer the QP to provide an organizational
structure, resources and coordination of quality processes within Regence. |
Regence Board of Directors and Health Care Services Committee
The Regence Board of Directors has participating providers as directors and
on the Health Care Services sub-Committee. This sub-committee meets quarterly
to discuss issues surrounding the health care delivery system and provider-related
quality improvement activities.
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