AvMed’s Quality Improvement Program: An Overview

By: AvMed News AvMed News

AvMed is determined to help its Members live a WELLfluent™ life. Delivering superior service to our Members is a key part of that mission. Through the Healthcare Effectiveness Data and Information Set (HEDIS), we can collect, analyze and report performance measurements on critical dimensions of care and service.

As an AvMed Provider, you have access to this information so you can see how well your patient does from one year to the next in getting the proper preventive screenings. These documents also provide a look at how our contracted network physicians are doing in delivering care according to professional standards.

AvMed’s HEDIS publications offer information on rates for measures such as:

  • Breast, cervical and colon cancer screenings
  • Diabetes care
  • Controlling blood pressure

We also provide resources for the Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Survey: CAHPS – Each year, the National Committee for Quality Assurance (NCQA) and the Centers for Medicare and Medicaid Services (CMS) require us to conduct a Member experience survey. Underway between February and June, these surveys measure the Members’ experience with the health plan, his or her provider, and various aspects of his or her care (e.g., Provider accessibility, communication, etc.).

HOS – The Health and Outcomes Survey (HOS) is a CMS survey that identifies areas for improvement in patient outcomes. The survey includes questions on several effectiveness of care measures, including urinary incontinence in older adults, physical activity in older adults, fall risk management and osteoporosis testing in older women.

HEDIS, CAHPS and HOS all have the ultimate goal of improving care for your patients – and you play a critical role. Here are some things you can do to improve care for your patients:

  • Submit claims on time and with the appropriate codes
  • Ensure records are complete, legible and accurate
  • Communicate effectively, making sure that patients understand any instructions

Want more information about AvMed’s Quality Improvement Program? Click here to visit the official webpage.