Quality Improvement Program

Advancing Population Health & Quality

Alterwood is advancing population health by integrating the services of care management, pharmacy management, utilization management, and quality improvement and leveraging data to drive our decisions. We have implemented a member and population centered model to promote continuity and coordination of care, remove barriers to care, prevent complications/adverse events and improve our populations’ quality of life; one member at a time.

Quality…At Alterwood, we have incorporated quality in everything we do.

Purpose of the QI Program

The primary objective of the Quality Improvement program (QIP) is to promote and build quality into the organizational structure and develop a systematic plan for monitoring, evaluating, and improving the quality of care and services for MAPD and D-SNP enrollees. Prioritizing and monitoring of the most vulnerable individuals in these populations, which include those who are frail, disabled, near the end of life and with multiple or complex chronic conditions. Alterwood’s QIP provides guidance for the management and coordination of all quality improvement and quality management activities throughout the organization, its affiliates, and delegated entities.

Scope of the QI Program

Quality is the core concept that drives each department at Alterwood. Everyone has a role and responsibilities in the QIP. The program is comprehensive, systematic, and based on policies, procedures, and clinical practice guidelines. We utilize best practices and standards from CMS, and relevant accreditation entities. The scope of Alterwood’s program includes quality planning, quality control and quality improvement functions.

Program Evaluation

Annually, Alterwood produces a Quality Improvement Evaluation that evaluates the performance and results of the Quality Improvement Program in the prior year. Based on the results, the program’s goals and objectives for the coming year are tracked in the Quality Improvement Work Plan.

Quality Committee Structure

Alterwood maintains a committee structure to support the flow of quality information throughout the organization and to the Board of Directors who has the ultimate responsibility for the quality of care and service provided by the organization.

Health Care Plan Effectiveness Data and Information Set (HEDIS)

HEDIS is developed and maintained by the National Committee for Quality Assurance (NCQA), an accrediting body for managed care organizations. The HEDIS measurements enable comparison of performance among managed care plans. HEDIS measures are reported annually in June for the prior year. All records are handled in accordance with Alterwood’s privacy policies and in compliance with the Health Insurance Portability and Accountability Act (HIPAA) Privacy rules.

Only the minimum necessary amount of information, which will be used solely for the purpose of this HEDIS initiative, will be requested. HEDIS is considered a quality-related health care operation activity and is permitted by the HIPAA Privacy Rule [see 45 CFR 164.501 and 506]. Alterwood’s HEDIS results are available upon request.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).