Why do we measure clinical quality outcomes?
To help our providers and practices best manage the care of our patients, we measure clinical quality outcomes and follow national guidelines on care management. Our health insurance risk contracts also require monitoring a number of measures and clinical outcomes.
The Triple AIM
The Winchester PHO uses the Triple Aim Approach as a guideline for managing the care of our patients. The Triple Aim consists of three parts:
- Improving the patient experience of care
- Improving the health of patient populations
- Reducing the per capita cost of health care
Our goal is to assist our practices and providers with different initiatives and processes that foster the Triple Aim and provide the best possible, low-cost care for our patients.
As part of our pursuit of the Triple Aim, Winchester PHO monitors and reports on a number of clinical quality measures and health outcomes.
What & how do we measure?
We report clinical quality performance of health insurance plans and healthcare providers using the Healthcare Effectiveness Data and Information Set (HEDIS). Created by NCQA (National Committee for Quality Assurance), HEDIS is one of health care’s most widely used performance improvement tools. 190 million people are enrolled in health plans that report HEDIS results.
What happens to the results?
Because meeting quality performance metrics is important to both the health of our patients and our managed care contracts, we monitor results closely and provide monthly updates to physicians and practices.
There are a number of monthly reports with information relevant to our quality performance for risk contract patients. All reports can be found in the WinPHO Membership Team Drive in Google:
- Patient lists
- Practice quality performance dashboards
- Medication management lists
- Individual provider gate scorecards
- Ace referral reports
If you or your practice would like additional information or support, Winchester PHO is available for assistance.