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New Initiatives & Opportunity for Improvement

Opportunities for improvement that are identified in the 2021 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 2022 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

In 2022, 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: 2022

  • Reduce non-value-added activities as they relate to inpatient hospital reviews
  • Accreditation: Review and monitoring of UM, appeals and credentialing system controls
  • Case Management: Initiate Horizon Healthy Journey Survey to identify areas of opportunity
  • Utilization Management: Identify opportunities to streamline authorization process through enhanced automation thereby increasing provider and member satisfaction and reducing administrative burden
  • Utilization Management: Revision of UM Commercial Medical workflows to ensure inclusive care and service of BH

Horizon will pursue these initiatives in 2022 and include updates to activities in the QI Program Work Plan to monitor, track and trend progress toward goals.

HCM-PD-QM-008-0122