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Quality Improvement Program

The Quality Improvement (QI) program is an important part of your health plan.  The QI department supports NH Healthy Families’ goal of improving member healthcare. 

The QI Program monitors the quality of care and services provided in the areas below:

  • Making sure members get the care they need, when and where they need it
  • Making sure that members are receiving quality care
  • Cultural needs of our members
  • Member satisfaction
  • Member/Patient Safety and Privacy
  • Offering a wide variety of provider specialties
  • Health plan services members are using

The goal of the QI program is to improve member health. This is achieved through many different activities. 

Some of our Quality Improvement goals include the following: 

  • Good health and quality of life for all members
  • Care provided by Plan Healthcare Providers meets industry-accepted standards of care
  • Plan customer service meets industry-accepted standards of performance
  • Provide members with Preventive Care reminders annually
  • Incomplete or duplicate services will be kept to a minimum through QI activities across Plan departments
  • The Member experience will meet the Plan’s expectations
  • Compliance with all State and Federal laws and regulations
  • Evaluate the quality of health care through HEDIS® (Healthcare Effectiveness Data and Information Set). These scores tell us when you have received the type of care you need.

HEDIS® (Healthcare Effectiveness Data and Information Set) is a tool that helps us make sure our members are getting the care they need. We compare our results to the same results of other health insurance plans. Every year we like to share some of the quality improvement efforts and the results of our HEDIS® monitoring with you and let you know what we’re doing to improve your health.

We help our members get their recommended preventive exams and recommended medical care for chronic conditions.  We also remind our Participating Providers that their patients are due or past due for their recommended screenings. In 2019, if you were past due for a service, you and/or your doctor may have received one of our educational letters or calls to remind you about checkups you should have.  Our outreach programs help you be the healthiest you can be.

In 2019, NH Healthy Families completed member and provider focused improvement interventions in the following areas:

  • Anti-Depressant Medication Management
  • Breast Cancer Screening
  • Chlamydia Screening
  • Cervical Cancer Screening
  • Colorectal Cancer Screening
  • Comprehensive Diabetes Care
  • Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications
  • Childhood Immunizations
  • Well Child Visits

NH Healthy Families continuously reviews our successes and opportunities for improvement and every year we look at our final results and select the HEDIS® Measures that need improvement for the following year.

2019 Quality Improvement Successes

ABBREVIATION MEASURE MY 2019 MY 2018 MY 2017 BENCHMARK ACHEIVED*
FUA Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence - Total - 7-Day Follow Up 26.03 21.03 18.87 90%
FUM Follow-Up After Emergency Department Visit for Mental Illness  - 7-Day Follow up 74.34 77.46 74.56 90%
PPC Prenatal and Postpartum Care - Postpartum Care 82.00* 66.18 65.21 90%
SPC Statin Therapy for Patients with Cardiovascular Disease - Adherence - Total 79.26 71.88 70.64 90%
UOP Use of Opioids From Multiple Providers - Multiple Prescribers and Multiple Pharmacies (lower is better) 0.99 0.75 23.43 90%
W15 Well-Child Visits in the First 15 Months of Life - 6+ Visits 76.89 73.24 76.64 90%

*For PCP Prenatal and Postpartum Care - Postpartum Care, the rate of increase for 2019 could be due to a change in the measurement.

2019 Quality Improvement Opportunities for Improvement

ABBREVIATION MEASURE MY 2019 MY 2018 MY 2017 BENCHMARK ACHEIVED*
CHL Chlamydia Screening in Women - Total 49.10 45.55 46.91 25%
WCC Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents - BMI Percentile - Total 75.67 78.59 77.13 25%
APM Metabolic Monitoring for Children and Adolescents on Antipsychotics Total 36.53 29.65 29.27 50%
LSC Lead Screening 73.90 70.27 66.01 50%
MMA Medication Management for People With Asthma - Medication Compliance 75% - 5 to 64 yrs (total) 42.34 41.88 45.48 50%
SSD Diabetes Screening for People With Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medication 82.61 79.23 83.61 50%

* National Medicaid Quality Compass Benchmark - Measurement Year 2019

At NH Healthy Families, your health means the world to us. As you can see, we are working hard to make sure you get the best care you need, when you need it. We are always trying to improve and your comments are important to us. NH Healthy Families created a Member Advisory Council so we could get and use your feedback.

NH Healthy Families also uses a survey called the Consumer Assessment of Healthcare Providers and Systems (CAHPS), to ask our members how we are doing. Every year you will have a chance to fill out the survey. You can tell us about your member experience and the services you received. You can also tell us about the availability of your primary care provider (PCP) and how you were treated. The results of this survey are reviewed by NH Healthy Families and they are anonymous. The results show us where we need to make improvements. Below are the results of some of the areas we ask about in the survey:

MEASURE 2019 2018
Getting Needed Care 84.10% 86.50%
Rating of Specialist 84.00% 87.00%
Rating of Health Plan 57.90% 62.40%
Rating of Personal Doctor 84.70% 83.40%
Rating of Health Care 77.60% 77.50%
How Well Doctors Communicate 94.10% 94.30%
Customer Service 91.60% 91.80%

Please call Member Services or visit our ‘Contact Us’ page on the website to tell us how we can better serve you. You can also tell us if you would like to become a member of the Member Advisory Council. We want to hear from you.

Call Member Services at 1-866-769-3085 (TDD/TTY 1-855-742-0123).