QI Program’s Function
The function of the QI Program is to coordinate, oversee, guide, and assess Braven Health efforts to ensure that continuous quality improvement is being pursued throughout the organization. The following sections highlight the functions of the QI Program. In addition to focusing on these functions, the Braven Health QI Program has the ability, through the QIC, to add additional areas on which to focus its attention.
Each year the QI Program Description is reviewed and revised as necessary. Annually, a QI Work Plan is developed and implemented to guide the execution of the QI Program. At the conclusion of each year, a QI Program Evaluation is completed to assess the success of the QI Program and guide the creation of the following year’s QI Program Description and Work Plan, looking at those areas where goals were not met and will continue to be monitored into the next calendar year. The work plan is monitored, reviewed and updated on a quarterly basis and new initiatives are added as needed.
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Compliance with State and Federal Regulatory and CMS Guideline Requirements
Credentialing and Re-credentialing
Clinical Practice Guidelines (CPGs)
Cultural Competency and Health Literacy
New Initiatives & Opportunities for Continued Improvement
Promoting safety for its membership is a key focus for Braven Health and involves a wide range of activities. The QI Program, as well as the Quality Management Department, are central contributors and coordinate the member safety initiatives performed throughout the organization.
To promote safety for hospitalized members and in accordance with the CMS guidelines and NJ state law, Horizon, in operating the Braven Health Quality Program, has policies to address quality of care and service, hospital acquired conditions and serious adverse events. The Quality Management Department reviews CMS regulations, applicable state laws, national clinical practice and other guidelines at least annually. Policies are reviewed and approved annually including a review of the list of selected hospital-acquired conditions and serious adverse events.
Additional activities occurring within the Quality Management Department and QIC that focus on enhancing member safety include: assisting in the reporting of quality indicators to the provider network, monitoring and follow up on corrective action plans required from delegated vendors and/or network providers who identified care and/or service deficiencies. Other activities include conducting quality of care reviews focused on member safety issues, designing quality improvement projects targeted at at-risk populations, researching grievances related to member safety issues, analyzing under and over utilization data, and when appropriate, coordinating Braven Health’s response to potential urgent/immediate member safety threats.
Disparities in Health
Disparities in health may impact the overall quality of care provided within the health care system while increasing health care costs. To address the multiplicity of the needs of the membership, the Braven Health QI Program works to identify and address disparities in health outcomes among different member populations. Annually, a population assessment is conducted that identifies social determinants of health and uses the evaluation to review and update the Plan’s Population Health Management activities and resources. Community resources are also integrated into program offerings to ensure member needs are met.
COMPLEX HEALTH NEEDS
The Braven Health QI program is dedicated to addressing the needs of members with complex health issues. The Complex Case Management Program integrates all components of case management and coordination to support access to care for members with complex diseases and chronic conditions. Members are identified and referred for Complex Case Management using a variety of methods, such as data provided from utilization/concurrent review, predictive modeling tools, discharge planners, physician or member/caregiver referrals and health information lines. The assigned case manager coordinates care with members, their families, and providers as appropriate to assist in assessment, development and implementation of individualized plans of care to meet the identified needs of the member across multiple settings. The Care Management Department utilizes the Care Radius medical management system to support both the delivery and documentation of the case management process.
Additionally, the Network Contracting & Servicing Department reviews geographic access reports to address the adequacy of the provider network. Reporting assesses sufficiency of PCP and high volume and high impact specialties required to serve the membership. Identified deficiencies in the network are addressed to reduce barriers to care and to ensure continuity of care for members.
Quality Assurance
GRIEVANCES
CMS provides stringent guidelines related to the intake and resolution of grievances received from Medicare enrollees. In order to meet the requirements, grievances are resolved by a dedicated group in Service Operations. The focus is to review and resolve grievances regardless of where they originate within the organization. Grievances are received via telephone calls, written correspondence, cases directed to Horizon by beneficiaries or their advocates making calls to 1-800 Medicare, internal referrals and referrals from legislators on behalf of their constituents.
All grievances are reviewed in detail to identify the root cause of the issue. There is continuous collaboration among departments (including but not limited to UM, CM, Behavioral Health, Appeals, and Network Contracting) within the organization to review and resolve grievances. All grievances are handled within the CMS designated timeframe and follow all CMS guidelines as outlined in the Managed Care Manual Chapter 13; Medicare Managed Care Beneficiary Grievances, Organization Determinations, and Appeals Applicable to Medicare Advantage Plans, Cost Plans, and Health Care Prepayment Plans (HCPPs), collectively referred to as Medicare Health Plans. Staff members serve as liaisons between the member/provider, delegated vendors, and regulatory bodies, and they follow grievances through resolution. Grievance inventory is monitored on a daily basis in order to ensure they are acknowledged and resolved in a timely manner. Timeliness outcomes and trends are reviewed on a monthly basis to identify areas of opportunity. Quarterly grievance reports are presented to the Quality Board, the Member Services Satisfaction Committee and the Provider Services Satisfaction Committee for review. Please note that grievances may also be referenced as complaints.
QUALITY OF CARE AND SERVICE
Within the Horizon Quality Management Department acting as Horizon BCBSNJ’s resource in operating the Braven Health Quality Program, a department exists which is focused on quality of care issues. This group provides ongoing education to personnel regarding potential quality of care concerns and serious adverse events. This education includes the definitions/categories for quality-of-care referrals with direction on how staff can refer potential quality of care issues to the Quality Management Department for investigation. All instances where a quality-of-care issue and/or serious adverse event, hospital acquired condition, or provider preventable event may exist are presented to the Quality Peer Review Committee (QPRC) for discussion, determination of departure from quality standards and guidelines, and, when indicated, the issuance of an appropriate sanction to the responsible provider.
QPRC sanction determinations are forwarded to the Credentialing Department for inclusion in the provider's credentialing file. Quality-of-care referrals as well as provider sanctions are tracked and trended by the Quality Management Department. Entities that receive sanctions may be monitored by the Network Contracting & Servicing Department through telephonic and medical record audits, as well as onsite visits. When the QPRC sanctions providers, the QPRC may require the provider to establish and implement corrective action plans (CAPs). These CAPs are reviewed by the QPRC for completeness. The QPRC reports quality-of-care concerns (QOC), hospital-acquired conditions (HAC) and serious adverse events (SAE) to the QIC.
The Quality Management Clinical Operations RN staff provides education sessions to Horizon staff members regarding quality of care referral categories. These information sessions are conducted via WebEx (to accommodate staff who work from home). In addition to structured reviews of the criteria, the Quality Management staff provides support to all referring staff to ensure that referrals and grievances are created correctly.
Quality of Care Referrals are captured in a Tableau inventory and trend dashboard. This dashboard is updated daily, and includes all quality of care referrals and grievances for Braven Health. Information obtained from Tableau is reviewed monthly for trends and outliers. In the event unacceptable performance on a quality of care indicator persists, referrals are made to the Network Operations Department, which reports the results of its investigation to the Provider and Member Services Satisfaction Committees. These committees report to the QIC.
AUDITS AND REPORTS
The Braven Health QI Program has oversight of audits and analyses completed by multiple business areas. These audits and analyses are performed to meet accreditation standards. Reports from these audits provide Braven Health with insight as to how processes, information systems and components of the health care delivery system are performing. The following audits and analyses are performed with comprehensive reports then reviewed by the QIC:
- Geo Access Reports
- Appointment Availability Audit
- Office Manager Satisfaction Survey
- Behavioral Health Clinical and Quality Performance Measures
- Vendor Oversight Audit
- Interrater Reliability Testing
- UM and Credentialing System Control Audits
This effort is incorporated into the Braven Health QI Program Work Plan. As part of the QI program, the QIC uses the work plan to track the completion of these activities. The QIC reviews the results of these audits and analyses and may issues recommendations to each business area about how it can be modified to improve the usefulness of the output.
Policy Management
Annual policy review is conducted and presented to the QIC or the applicable subcommittee or workgroup of the QIC, by the department responsible for each policy. Policies affecting the delivery of health care and customer service are reviewed to comply with the Corporate Policy and Procedure Development Policy and include the effective date, most recent revision and most recent review dates. In addition, policies are reviewed for applicable regulatory and accreditation content. They are maintained on a SharePoint site to allow staff access to all current Braven Health policies.
Delegation Oversight
Delegated managed care entities that administer services which would otherwise be performed by the health plan are subject to review and oversight under the QI Program. These services include, but are not limited to, activities/functions relating to utilization review/management, case management, quality improvement, credentialing/re-credentialing, utilization management appeals, efforts to identify indicated preventative and chronic care services captured in HEDIS which do not appear to have been delivered and to promote the delivery of such services, diagnostic imaging and other diagnostic services, pharmacy benefit management, laboratory services, vision services, dental services, telemedicine, post-acute skilled nursing facility (SNF) and rehab care services, durable medical equipment, grievances, customer service and claims processing.
Contracted delegates/vendors are obligated to provide and administer services in accordance with contractual terms and conditions, applicable state and federal laws & statutes, including but not limited to, regulations set forth by the New Jersey Department of Banking and Insurance (DOBI), the Health Claims Authorization, Processing and Payment (HCAPP) Act, CMS regulations, Braven Health policies and procedures, and current-year NCQA standards and guidelines. Horizon, in operating the Braven Health Quality Program, remains accountable for the quality, integrity and appropriateness of delegated functions and services provided by subcontractors for Braven’s Medicare Advantage members.
It is Braven’s responsibility to ensure effective monitoring and oversight activities are performed to promote the delivery of and access to quality and cost-effective health care and services to members. The Delegate Vendor Oversight Committee is responsible for (a) assessing on-going monitoring and evaluation activities performed collaboratively and independently by Horizon business units acting as Horizon BCBSNJ’s resource in operating the Braven Health Quality Program, (b) evaluation of delegate/vendor performance results to ensure business goals and outcomes are achieved, and (c) ensuring delegate/vendor compliance with contractual obligations as outlined in their service agreements, regulatory requirements, and applicable accreditation guidelines.
Quarterly activity that is reviewed and discussed at DVOC meetings must be submitted and presented to the QIC. A summarized overview of delegate/vendor oversight activities must also be submitted to the Compliance and Ethics (C&E) Committee. Committee reports must include, but not be limited to, delegate/vendor performance measures and the status of any delegate/vendor CAP and, oversight monitoring, and must highlight matters of significance that require the attention of the QIC, HQCB or C&E Committee.
Compliance with State and Federal Regulatory and CMS Guideline Requirements
Braven places the utmost importance on compliance with regulatory and contract requirements. This is particularly important as it relates to member safety, the handling of private health information and the integrity with which the Plan serves its members.
Confidentiality
Braven Health processes address sensitive Protected Health Information (PHI). Documents containing PHI that are created and reviewed as part of health plan operations are confidential. The information is maintained in compliance with appropriate federal and state regulations, the Health Insurance Portability and Accountability Act (HIPAA) and all applicable accreditation standards. All employees, participating physicians, vendors and consultants are required to maintain the Braven Health standards of ethics and confidentiality regarding both member information and proprietary company information. All employees (and non-employees who are granted access to PHI and proprietary company information) are required to sign a confidentiality statement or Business Associate Agreement. In addition, certain business associates perform business functions acting as Horizon BCBSNJ’s resource in operating the Braven Health Quality Program involving the use, disclosure or receipt of member PHI. These third parties, which perform administrative functions on behalf of Braven Health also enter into formal Business Associate Agreements to protect the privacy and safeguard the security of PHI when assisting with administrative functions or providing services in operating the Braven Health Quality Program.Member Rights, Responsibilities and Patient Engagement
Braven Health is committed to maintaining a mutually respectful relationship with its members that promotes the delivery of effective health care. Braven Health makes clear its expectation for the rights and responsibilities of members and sets forth a structure for cooperation among members, practitioners and the health plan. Braven Health recognizes that members must establish a dynamic partnership in the management of their care, which includes members' families and their health care practitioner. When care does not meet the member's expectations, Braven Health offers members the right to voice grievances (complaints) and to appeal any health plan coverage or benefit determination with which they do not agree.Regulatory Compliance
The QI Program through the QIC:- Monitors adherence to regulatory requirements for quality management and compliance;
- Ensures that the appropriate actions are taken when instances of non-adherence to established requirements by the quality management department are identified; and
- Ensures the quality management reporting system provides adequate information for determining that Braven Health satisfies the regulatory, external review and accreditation requirements to which Braven Health is obligated and to which Braven Health voluntarily subjects itself.
Medicare Advantage Regulatory Requirements:
- Reviews and appropriately disseminates CMS guidance and communications to business stakeholders, thereby promoting the timely and accurate implementation of business practices necessary to meet new and revised requirements;
- Coordinates and facilitates all regulatory audits and external reviews to demonstrate compliance with applicable regulatory requirements and avoid adverse actions;
- Identifies, assesses, and discloses regulatory risks pertaining to the Medicare Advantage line of business; and
- Reviews Medicare Advantage marketing and communication materials to ensure clear, truthful, and regulatory-compliant language
Ethics
The Braven Health QI Program functions as a key component in promotion of integrity and corporate values found in the care and services provided to Braven Health members. Our corporate values drive our work and culture. They include striving for a culture of excellence, remaining member-focused and thinking innovatively. As outlined in the Corporate Code of Business Conduct and Ethics, Braven Health is committed to maintaining the highest legal and ethical standards in the conduct of its businesses. In maintaining these standards, Braven Health places heavy reliance on individual good judgment, honesty and character. This commitment applies without exception to all activities.
Credentialing and Re-credentialing
Braven Health credentialing and re-credentialing activities are administered by the Horizon BCBSNJ Credentialing Department. Horizon BCBSNJ’s credentialing and re-credentialing process determines whether practitioners and organizational providers meet all criteria as documented in our Administrative Policies. Primary source verification is conducted for all applicable State licenses (i.e. State Board License or certification, DEA, CDS), minimum professional liability insurance coverage, review of the National Practitioner Data Bank and State and Federal health care programs to ensure practitioners and organizations are in good standing and qualified to provide the care for which they have been credentialed. All practitioners and organizational providers are subject to credentialing upon initial application to join our networks and are subject to re-credentialing every 36 months thereafter. The Credentialing Department coordinates ongoing monitoring on a monthly basis to ensure that physicians, other health care professionals and organizational providers maintain their applicable licensure and remain in good standing in the medical community. The Credentials Committee votes weekly to approve applicants who meet all primary source verification elements. If criteria is not met, applications are presented to the Credentials Committee at a monthly Standard Business meeting for discussion and determination for new or continued participation. Urgent Business Meetings may be held at any time if there is an emergent quality of care issue that requires immediate discussion. Horizon maintains oversight of credentialing and re-credentialing activities through the Quality Improvement Committee.
Clinical Practice Guidelines (CPGs)
CPGs are evidenced-based practice standards adopted by Horizon in operating the Braven Health Quality Program. They are used to assist staff in making appropriate recommendations and to inform members and providers about making educated health care decisions. Topics addressed by CPGs include, but are not limited to, preventive health, asthma, diabetes, behavioral health and geriatric care. The CPGs are based on the standards and guidelines promulgated by respected professional organizations and government bodies and published in credible medical references. The guidelines are reviewed and updated at a minimum of every two years and they are presented to the UM/CM Committee for review and approval. Information about Braven Health CPGs is made available to providers through the Braven Health Provider Administrative Manual and provider newsletters. Additionally, Braven Health will follow Horizon BCBSNJ’s policies and procedures, including its medical policies. Providers may visit HorizonBlue.com/Braven Health for policy and CPG information. Guidelines are available to members through the Braven Health website, and upon request by calling the Member Services Department.
Cultural Competency and Health Literacy
Braven Health recognizes the cultural diversity and health literacy needs of its health plan members. The Plan is committed to promoting cultural competency, increasing health literacy, and decreasing health care disparities related to gender, gender identity or sexual orientation. Horizon, on behalf of Braven Health, obtains data from multiple sources to identify disparities in health care and health outcomes, and uses this information to develop and implement efforts that address cultural competency and health literacy. Education is provided to staff and participating providers to enhance the provision of culturally competent and linguistically appropriate care. Language assistance services, including bilingual staff and interpreter services, are provided to members at no cost when interacting with the Plan or health care providers. Braven Health produces member-related materials which are easily understood and in languages that meet member needs.
The objective of Braven Health cultural competency and health literacy efforts are to improve materials and communications by:
- Providing training on cultural competency, bias or inclusion for all employees and providers
- Promoting diversity in recruiting and hiring
- Gaining a better understanding of the needs of our members through solicitation of member feedback
- Optimizing members’ experience with the health plan
- Enhancing the provision of quality care to members with diverse values, beliefs and behaviors
- Encouraging the development of more effective strategies for communication with members
- Promoting health equity
In evaluating cultural, racial, ethnic and linguistic needs, Horizon, in operating the Braven Health Quality Program, performs the following:
- Identifies linguistic needs and cultural backgrounds of members, by using U.S. Census data, Pew Research data, Appointment Availability surveys, language preference data collected at enrollment and member feedback
- Conducts population assessments annually to assess the cultural, racial, ethnic and linguistic needs of its member populations
- Identifies languages spoken by practitioners in provider networks to assess whether they meet members' linguistic needs and preferences
The data from these reports is analyzed and used by Horizon, in operating the Braven Health Quality Program, to adjust the practitioner network if the current practitioner network does not meet members' language needs and preferences. Where there is a deficiency, efforts are made to recruit providers and practitioners to meet the needs of the underserved groups.
Additionally, case managers identify member cultural, physical, behavioral health, auditory, vision and linguistic barriers to care as a part of the Complex Needs Assessment process. Member needs are assessed and barriers are addressed throughout the continuum of care.
Fraud, Waste, and Abuse
The Fraud, Waste and Abuse Prevention Plan documents the organization's comprehensive approach to prevent, detect, investigate, recover, and report cases of fraud, waste, and abuse. Policies and workflows are in place that provide the framework for monitoring compliance with the following fraud, waste and abuse-related requirements:
- Federal Program Fraud Civil Remedies Act, New Jersey False Claims Act
- New Jersey Anti-Fraud Prevention and Detection Plan Protocol, (N.J.A.C. 11:16-6.7)
Braven Health may routinely discover issues that require intervention and analysis. Various sources of information are used to aid in monitoring and identifying fraud, waste and abuse. These include daily queries, SAS analytical software (used for statistical analysis and criminal investigations), referrals from internal departments, external referrals (i.e. pharmacy audit vendors, and fraud hotline) and media publications. Braven has engaged the Horizon BCBSNJ’s Medicare Special Investigations Unit (SIU) to coordinate fraud waste and abuse activities with all state and federal agencies. If a potential issue is identified, the information is reported to Horizon SIU acting as Horizon BCBSNJ’s resource in operating the Braven Health Quality Program for evaluation and further action.
Program Performance
In its role administering the Braven Health Quality Management Program, Horizon BCBSNJ dedicates resources across the organization, and specifically within the Quality Management Department, to focus on Braven Health Quality Performance. This work is guided by the QI Program and included in the QI Program Work Plan. The QIC as directed by the Braven Health Board’s Quality Subcommittee, which has oversight of this work including the planning, monitoring and evaluation of the outcomes of these efforts.
QI PROGRAM WORK PLAN
Annually, the Quality Management Department creates the QI Program Work Plan. The work plan is presented to the QIC in the first quarter of the year. The QIC provides recommendations for revisions and the committee reviews and, after deliberation and any revisions, approves the work plan. The QI Program Work Plan is designed to be inclusive of all aspects of the QI Program’s responsibilities. The work plan is updated by the QIC as needed during the year to incorporate recommendations that are identified through the completion of the QI Program Evaluation and/or by recommendations made by the QIC. The QIC reviews the work plan at least quarterly to ensure that the activities outlined within the work plan are being addressed by the appropriate business owners, and to ensure progress is being made toward the stated goals. If the QIC determines that progress is not being made toward goals, the committee is tasked with providing recommendations to assist the business area in identifying barriers and developing interventions to overcome the barriers.
PERFORMANCE IMPROVEMENT PROJECTS (PIPS)
A performance improvement project (PIP) is a concentrated effort on a specific problem within the health plan. Information is systematically collected to identify issues or problems, which then become the focus for improvement activities. Interventions are monitored to ensure they are driving the intended improvements. The Plan develops and conducts PIPs to examine and improve care or services for members in areas with identified deficiencies. Deficiencies are determined following analysis of performance against a specific standard.
The Quality Management Department is responsible the design, implementation, execution, analysis, and reporting of Braven Health CMS-required Chronic Care Improvement Projects (CCIPs). Plan Do Study/Check Act cycle and Lean Six Sigma methodologies are used to develop and ensure continuous quality improvement throughout the duration of each CCIP.
MEDICARE CHRONIC CARE IMPROVEMENT PROJECTS (CCIPS)
Braven Health participates in ongoing quality improvement programs for its Medicare Advantage contract. The purpose of the QI Program is to ensure that Braven Health has the necessary framework and infrastructure to coordinate care, promote quality, performance, and efficiency on an ongoing basis. The guidelines followed and incorporated into the QI programs are based on the 42 CFR§ 422.152 regulation. Each CCIP applies to the active MA contract and has a three-year project cycle. Braven Health is not required to submit updates for its Medicare CCIPs to CMS, but monitors CCIPs internally and submits an attestation that confirms the projects are in place.
HEALTHCARE EFFECTIVENESS DATA AND INFORMATION SET (HEDIS)
Performance on HEDIS measures for Braven Health is evaluated and analyzed monthly. Initiatives are developed, revised, and/or enhanced based on measured performance. Initiatives and outreach activities are addressed in HEDIS subcommittee meetings. HEDIS performance results are reported annually to the NCQA, internally to the QIC, and reported to the Quality Committee of the Board in review of the QI Program Evaluation. Existing initiatives and outreach areas are evaluated for their impact and, if appropriate, are enhanced to improve measure performance. The results and outcomes of initiatives and outreach are monitored monthly and shared in HEDIS Workgroup meetings held four times per year.
STAR RATINGS
Star Ratings are utilized by CMS to rate Medicare Advantage (MA) plans on a scale of 1 to 5 Stars, with 5 representing the highest quality outcome. The summary score assigned to a plan provides an overall measure of the plan’s quality and is a cumulative indicator of the quality of care, access to care, responsiveness and beneficiary satisfaction provided by the plan. These ratings are posted on the Medicare website to provide beneficiaries with additional information to help them choose and compare MA plans offered in the area. These ratings are made public in October of each year, which is in time for open enrollment. Health plans with a Star Rating of 4 or 5 Stars are eligible for a quality bonus payment from CMS.
Horizon, in its role administering the Braven Health Quality Program, has developed an organized, well defined structure to ensure that all Star Rating metrics are evaluated, tracked and where necessary, improved. The program’s performance, including the detail of each measure, is reported up to executive leadership. Medicare Star Rating measures are monitored monthly. Responsibility for performance on Star Rating measures are assigned to business owners who develop strategies, initiatives and outreach activities to maintain and/or improve performance. Performance on Star Rating measures are reported through the Stars Steering Committee, CAHPS Council, and the Stars Program Weekly Workgroup. Additionally, Star Rating progress is reported to the QIC on a quarterly basis and to the Quality Committee of the Board through review of the QI Program Evaluation. This ensures that results are consistently tracked and trended at the highest level, and that the program continues to receive the support and attention it needs.
CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (CAHPS)
The CAHPS survey captures information about member-reported experiences and how well the Plan and providers are meeting members’ expectations and goals. The Horizon Quality Management Department in its role administering the Braven Health Quality Program coordinates efforts intended to improve performance on CAHPS survey items for Braven members. The planning, work and results of these efforts are reported to the QIC. Specific CAHPS work plans are created for each line of business. In 2023, Braven Health will determine which opportunities exist so that efforts can be developed to yield positive results on key measures. These are all drivers of customer satisfaction and impact the Plan’s overall ratings. The QI Program Work Plan will incorporate the QIC’s oversight of CAHPS improvement initiatives.
HEALTH OUTCOMES SURVEY (HOS)
The Health Outcomes Survey (HOS) provides an assessment of how Braven Health members describe changes in their health status over time. The survey is administered by SPH Analytics, a CMS certified vendor, to a random sample of Medicare beneficiaries. Horizon BCBSNJ’s Customer Experience Department, acting as Horizon BCBSNJ’s resource in operating the Braven Health Quality Program, analyzes the results of the HOS survey and this analysis is presented to the QIC for discussion and recommendations for interventions that can be put in place to improve survey results. Review of the HOS survey results is included in QI Program Work Plan.
New Initiatives & Opportunities for Continued Improvement
Opportunities for improvement that were identified in the 2022 QI Program Evaluation will be incorporated into the 2023 QI Program activities for implementation and monitoring by the QIC. These opportunities will require new initiatives to be developed that will yield a positive impact on the quality of care and service Braven Health provides its members, and will have direct monitoring by the QI program because of their scope and impact on members and providers. Horizon, in operating the Braven Health Quality Program, will track these opportunities for improvement in 2023 and include updates to activities in the QI Program Evaluation for future Braven Health Success.
New initiatives for 2023 include:
- Conducting efforts to ensure that pursuing initial accreditation by the National Committee for Quality Assurance (NCQA) is attainable for Braven Health
- Expansion of Braven Health website content and functionality to meet NCQA requirements
- Horizon partnered with a food services vendor to provide Braven members with healthy food packages as a result of receiving member education regarding the importance of annual screenings, key points for discussion with providers and completing care gaps
- Telephone hold messaging will be utilized to remind members on the importance of getting the flu vaccine
- PCP practices will receive rewards for attending monthly webinars focused on CAHPS measures with additional incentives for those that receive an average performance of 4 Stars
Opportunities for improvement include, but are not limited to:
- Improving clinical performance with a focus on measures that fell below the NCQA 50th percentile
- Implementing initiatives focused on improving and maintaining Star Ratings
- Improving CAHPS® performance
Braven Health will pursue these opportunities for improvement in 2023 and include updates to activities in the QI Program Work Plan to monitor, track and trend progress toward goals.