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Purpose Statement for Group Health Cooperative of Eau Claire
Optimize the health care of our members through the Cooperative's pooling of health-related resources.
Mission Statement for the Quality Improvement Program
To identify, assess, measure, and evaluate improvement opportunities through collaborative network efforts in order to meet or to exceed stakeholders’ expectations.
Overview
Group Health Cooperative is committed to quality improvement and strives to incorporate this philosophy and practice throughout all areas of the organization. Customer service, employee involvement, and the commitment of leadership to continuous improvement are essential to the program.
The structure of Group Health Cooperative includes the use of ad hoc multi-disciplinary committees, as well as standing Quality Improvement committees to support the Quality Improvement program and activities. Quality Improvement studies, findings and interventions are used to improve operational and member-related processes.
Organizational Integration
The Quality Improvement program is coordinated with, and lends support to, all areas of the organization. All areas participate in Quality Improvement activities as delegated by management. The Quality Improvement program coordinates and lends support to strategic planning, marketing, provider credentialing, health management, member services, enrollment, ancillary services, information systems, and claims administration.
The Quality Improvement program extracts, compiles, and analyzes data reporting key findings that assist management in making sound business decisions affecting both member and operation outcomes.
Program Oversight and Accountability
The Board of Directors has delegated responsibility for the Quality Improvement program to the General Manager. The Board of Directors’ Member Relations Committee reviews member satisfaction survey results.
Group Health Cooperative commits to our members activities that improve performance, provide systematic monitoring and evaluation using evidence based disease management protocols. The following activities are related to Quality Improvement.
- Identify clinical quality indicators that improve our members’ health status
- Review, interpret, and share results of clinical studies
- Review HEDIS results and design possible interventions
- Review Preventive Care Guidelines, adapt them to membership populations, revise and update guidelines as changes occur, distribute and promote the use of the guidelines with contracted providers
- Review provider practice patterns
- Design, promote, and monitor health management programs
- Develop and monitor measures to ensure patient safety
- Review performance of the two disease management programs—asthma and diabetes
- Oversight of peer review activities (Medical Director)
- Oversight of delegated peer review agreements and events
- Review “quality of care” concerns
- Review member deaths
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