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QI Program Objectives/Goals

The Braven Health QI Program is designed to produce prospective, concurrent, and retrospective analyses of the Plan’s activities in order to improve the quality of care and service members receive. The specific goals of the QI Program are to ensure that Braven Health:

  • Promotes health care that is reasonable and necessary with an emphasis on the maintenance and improvement of health in an safe, effective and efficient manner
  • Assesses the appropriateness and timeliness of the care and services being provided/
  • Promotes members’ ability to maintain themselves in the least restrictive setting of their choice, as allowed by their health status, physical capabilities and behavioral health conditions.
  • Optimizes care delivery for members with special and/or complex care needs
  • Identifies members’ needs and coordinates care to address the needs of the member
  • Focuses on the quality of medical and behavioral health care and services provided to all members
  • Works to identify and reduce health care disparities related to race, ethnicity and other demographic and socio-demographic factors within its membership
  • Strives to improve member and provider satisfaction with access to health care and the effectiveness of care
  • Maintains oversight of delegated entities
  • Maintains oversight of the credentialing and re-credentialing of providers
  • Works to improve plan performance on HEDIS, Stars, CAHPS, HOS and Chronic Care Improvement Program (CCIPs)

Program Evaluation

The QI Program is evaluated annually. This evaluation is performed by the Horizon Quality Management Department, which is engaged by Braven Health to staff and operate its Quality Management Program under the direction of the Quality Improvement Committee (QIC) overseen by the Braven Health Board’s Quality Subcommittee. The format of the QI Program Evaluation parallels the QI Program’s Work Plan and includes:

  • A description of completed and ongoing quality improvement activities that address quality of clinical care and quality of service
  • Evaluation and assessment of member safety activities
  • Tracking and trending of data to assess program performance related to quality of care and quality of service
  • An analysis of improvements in quality of care and service to members
  • A critical assessment of barriers to achieving goals and root cause analysis
  • An evaluation of the overall effectiveness of the QI Program

The QI Program Evaluation is presented annually to the Braven Health QIC for review, comments, and approval. The Vice President and Chief Medical Officer, or a designee, annually presents the QI Program Evaluation to the Braven Health Quality Committee, which in turn presents this Program Evaluation to the Braven Health Board.