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Quality Improvement Program

NH Healthy Families' Quality Improvement (QI) Program focuses on preventive health. The program creates plans, puts those plans into action, and measures efforts to improve your health and safety. 

The QI Program strives to make a difference in health outcomes. It develops actions to improve member and provider satisfaction. NH Healthy Families involves providers within our plan. The providers assist with developing and monitoring activities of the QI Program as well as providing insight into preventive health resources and information.

For questions about the QI Program and our progress on meeting goals, call the Member Services department at 1-866-769-3085 (TDD/TTY 1-855-742-0123).

The QI Program also reviews services provided to our members. We have clinical practice guidelines for certain conditions. If you would like a copy of these guidelines or need more information about programs call us at 1-866-769-3085 (TDD/TTY 1-855-742-0123).

Information and/or a full copy of NH Healthy Families' current QI Program Description is available upon request.

Quality Improvement Program Updates - 2016

NH Healthy Families cares about you and the healthcare you receive. In 2016, we completed many quality improvement projects to help us see if our members are completing their recommended care and our participating providers are giving the recommended services to our members.

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 2016, 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 2016, 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
  • 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 assess 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.

The tables below will show some of our 2016 quality improvement successes and some of our opportunities for improvement for 2016.

2016 Quality Improvement Highlights

MEASURE

2014

2015 

 2016

BENCHMARK ACHIEVED*

Childhood Immunization Status: Combination 10 (CIS) 37.87% 37.59% (↓) 46.51% (↑) 90th

Comprehensive Diabetes Care: Eye Exam (CDC)

59.76%

65.63% (↑)

70.36% (↑)   

90th

Antidepressant Medication Management: Effective Acute Phase Treatment (AMM)

43.94%

62.00% (↑)

60.28% (↓)  

90th

Adult BMI Assessment (ABA) N/A 79.76% 91.11% (↑)

75th


* National Medicaid Quality Compass Benchmark - Measurement Year 2015

2016 Quality Improvement Opportunities for Improvement

MEASURE

2014 

2015 

2016 

BENCHMARK ACHIEVED*

Well Child Visits in the Third, Fourth, Fifth, and Sixth Years of Life (W34)

79.29%

78.85% (↓)

81.97% (↑)

75th

Breast Cancer Screening

N/A

N/A

60.18

50th

Antidepressant Medication Management: Effective Continuation Phase Treatment (AMM) 27.27% 43.33% (↑) 42.82% (↓) 50th
Comprehensive Diabetes Care: Medical Attention for Nephropathy (CDC) 77.53% 87.67% (↑) 88.27% (↑) 10th 


* National Medicaid Quality Compass Benchmark - Measurement Year 2015

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.

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 855-678-6975 (TDD/TTY: 1-866-614-1949).