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New Initiatives & Opportunity for Improvement

Opportunities for improvement that are identified in the 2022 QI Program Evaluation are incorporated into the following year’s QI Program activities for implementation and monitoring by the QIC. These opportunities may require new initiatives to be developed that will yield a positive impact on the quality of care and service. Horizon will track these opportunities for improvement in 2023 and include updates to activities in the QI Program Evaluation. Opportunities include, but are not limited to:

  • Improving HEDIS performance
  • Addressing gaps and opportunities for improvement with underperforming delegates
  • Improving CAHPS performance for the Commercial line of business
  • Improving physician compliance with appointment availability standards
  • Improving BH Average Speed of Answer (ASA) and Call Handle Time
  • Improving annual BH provider satisfaction survey results
  • Increase follow-up After Hospitalization for substance Use IP admissions
  • Improving BH post call survey member and provider satisfaction
  • Improving performance with Care Management engagement with the application of new member BH Health Risk Identifier Report

In 2023, Horizon will be embarking on multiple new initiatives. While all of Horizon’s new initiatives have the potential to impact the quality of care and service provided to members, the following specific initiatives require direct monitoring by the QI program because of their scope and impact on members and providers.

Initiatives: 2023

  • Reduce non-value-added activities as they relate to inpatient hospital reviews
  • Successfully complete NCQA renewal survey
  • Case Management: Initiate Horizon Healthy Journey Survey to identify areas of opportunity
  • NCQA Social Determinants of Health (SDOH) Referral Source Development
  • Develop Predictive modeling tool to identify rising risk members of case management enrollment
  • Utilization Management: Incorporate automation into UM processes to reduce administrative work and improve operational efficiency
  • Implement in collaboration with Provider Services IVR updates to improve provider experience with the UM process
  • Continue Behavioral Health Integration efforts
  • Continue to expand BH network access to children and adolescents as well as expansion of specialty telehealth providers

Horizon will pursue these initiatives in 2023 and include updates to activities in the QI Program Work Plan to monitor, track and trend progress toward goals.

HCM-PD-QM-008-0123