Quality Improvement
Quality Improvement
GlobalHealth health plan operates under a Quality Improvement Program that strives to ensure that enrolled members have access to high quality health care services that are safe, effective, and responsive to their needs, resulting in positive health outcomes. Within the scope of its Quality Improvement Program, GlobalHealth monitors and evaluates the important aspects of care and service rendered to members through routine health plan reporting, annual HEDIS and CAHPS results, assessment of provider and member satisfaction, accessibility and availability standards, utilization trends, and other quality improvement studies. The GlobalHealth Quality Improvement Program extends to all departments within the organization, at all levels, in the recognition that teamwork and collaboration are essential for quality improvement.
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) is conducted annually for members of GlobalHealth. This survey measures consumer satisfaction with both providers and the health plan. �H E D I S� stands for Healthcare Effectiveness Data and Information Set and is the industry-wide set of measures used by health plans and purchasers of insurance to evaluate various performance rates in clinical and non-clinical functions. GlobalHealth uses both HEDIS and CAHPS rates to identify areas of strength and opportunities for improvement.
Another important element that supports the quality program of GlobalHealth is the use of evidence based guidelines and nationally recognized recommendations as the basis of clinical decision making to help improve member outcomes in care through the reduction in variation in the diagnosis and treatment of disease. Clinical Care Guidelines were adopted through nationally recognized organizations including the American Diabetic Association (ADA) and the National Heart, Lung and Blood Institute (NHLBI).
To assess the effectiveness of the Quality Improvement Program, GlobalHealth produces an annual evaluation that emphasizes the achievements made in the clinical care and service provided to members within the past year. The 2008 QI Program Evaluation identified improvement that included the following functional areas:
- Appeals and Grievances
- Physician Satisfaction
- Claims Handling and Processing
- Call Center Member Services
The Quality Improvement Program is reviewed and approved by a board consisting of physicians and experts in the field of quality from throughout the country. The National Quality Board is chaired by the Chief Medical Officer. The Medical Director of GlobalHealth is a voting member of the National Quality Board and chairs the Quality Improvement Committee of the health plan.
If additional information regarding the Quality Program of GlobalHealth is desired, consumers may contact the GlobalHealth Member Services at:
Local: 405-280-5600
Toll-Free: 1-877-280-5600
TTY/TDD: 1-800-522-8506
Monday - Friday 9 am - 5 pm (CST)
E-mail: AskCustomerService@globalhealth.com