You have been appointed as Director Quality Improvement in a large Health Maintenance Organization?

You have been appointed as Director Quality Improvement in a large Health Maintenance Organization?


You have been appointed as Director Quality Improvement in a large Health Maintenance Organization. Your 2004 customer satisfaction survey (CAHPS) shown members being dissatisfied with accessibility and quality of care provided. In addition the (HEDIS) Preventive studies have shown results are below the benchmark in Annual Eye exam screening for Diabetes patients (members). It is now your responsibility to proceed with improving the Quality within your organization. How will you proceed?

You have been appointed as Director Quality Improvement in a large Health Maintenance Organization?
Walk down to the VP of provider relations and ask why the network is deficient and ask if a "wrap" network is in place and if so, why aren't the enrollees aware of it. If your members have a lot of hoops to jump through to access care, talk with the Medical Directors about removing a few.


If the annual diabetic retinopathy eye exam screening is a covered benefit (it might not be), ask the Medical Directors for a budget to do a post card mailing to the target patient group. A phone call, post card a monetary incentive and then a followup call should be enough to improve this metric.
Reply:CONGRATULATIONS........It's up to you.