We want our members to receive the best care. We have a Quality Improvement Health Equity (QIHE). Program to help us meet this goal and to fix any problems that we find. The QIHE Program is designed to continuously improve the health of our members, and their healthcare experience, and ensure equitable care for all. Each year we set higher goals to improve the service we provide. Through the use of different data sources, the Alliance can measure the effectiveness of our initiatives, identify opportunities for improvement, and implement interventions designed to support our providers and members.

Contact

Provider feedback is important to the success of our QIHE program. If you would like to share your suggestions about our QIHE program, or request more information about the Alliance’s QIHE Program, or to request a paper copy of our detailed QIHE Program Description, please contact:

Program Description and Work Plans

Program Goals

Below are program goals for the QIHE program:

  • Ensure equitable care for all
  • Help doctors and hospitals improve quality of care
  • Help members get the best care
  • Increase member and doctor satisfaction
  • Measure and improve the quality of our service

Program Scope

The scope of the QIHE program is comprehensive and encompasses major aspects of care and service in the Alliance delivery system, and the clinical/non-clinical issues that affect our membership.

These include:

  • Acute, chronic, and preventive care services for children and adults
  • Availability and access to care, clinical services, and care management
  • Case review of suspected instances of poor quality
  • Clinical practice guideline development, compliance, and revision
  • Continuity and coordination of care
  • Credentialing and recredentialing services.
  • Cultural and linguistic issues
  • Member and provider satisfaction
  • Patient safety
  • Perinatal, primary, specialty, emergency, inpatient, and ancillary care
  • Special needs populations including Seniors and Persons with Disabilities or persons with chronic conditions
  • Utilization trends including over-and under-utilization

Methods and Procedures

The Alliance uses several methods to identify aspects of care that are the focus of QI activities.

CAHPS 5.1H®

Annually, the Alliance measures member satisfaction using the CAHPS 5.1H® (Consumer Assessment of Healthcare Providers and Systems) survey. Also known as the Member or Patient Experience, the survey looks at health plan performance and members’ experiences in the provider office. The survey is sent to members and parents of child members every spring. The Alliance uses the survey results to identify opportunities to improve member satisfaction. For more information about CAHPS 5.1H®, please click here.

HEDIS®

The Alliance’s QIHE strategies focus on the measurement of quality and identifying opportunities for improvement. One way we assess our quality of care is through HEDIS (Healthcare Effectiveness Data and Information Set). For more information about HEDIS® and tools to help you with the HEDIS® measures, please click here.

Other Data Sources

Data sources used to identify areas of improvement also include, but are not limited, to the following:

  • Claim and encounter submissions
  • Credentialing, medical record review, and audit findings
  • Pre-service, concurrent, post-service and pharmacy utilization review data
  • Member and provider grievance and appeal data
  • Potential Quality Issue tracking/trending data

Annual Work Plan

The Alliance prepares an annual QIHE Work Plan that describes the quality management goals and objectives, planned projects, and activities for the year, including continued follow-up on previously identified quality issues, and a mechanism for adding new activities to the plan as the need is identified. The work plan delineates the responsible party and the time frame in which planned activities will be implemented.

The work plan addresses the following:

  • Activities to close health disparity gaps
  • Evaluation of the QIHE program
  • Monitoring previously identified issues
  • Program scope
  • Quality of clinical care
  • Quality of service
  • Safety of clinical care
  • Staff member responsible for each activity
  • Time frame within which each activity is to be achieved
  • Yearly objectives
  • Yearly planned activities

Population Needs Assessment

The Population Needs Assessment (PNA) is the mechanism the Alliance uses to identify the priority needs of our local communities and members and to identify health disparities. The Alliance meaningfully participates in the Community Health Assessments (CHAs)/and Community Health Improvement Plans (CHIPs) conducted by Local Health Jurisdictions (LHJs). These collaborations provide a deeper understanding of the health and social needs of the community to improve the lives of members more effectively.

The LHJs in Alameda County are Alameda County Public Health Department and City of Berkeley. The Alliance attends regular collaborative meetings and is committed to sharing both data and resources with our LHJ partners.

Alameda County Public Health Department

The Alliance began to meet with Alameda County Health in 2023 to explore partnerships with the Alameda County Public Health Department’s CHIP signature programs and develop a shared objective. In 2024, the Alliance attended the CHIP kickoff meeting in May and will continue to stay involved in CHIP focus area workgroups. The Alliance plans to partner with EmbraceHer, Front Door, Office of Violence Prevention, and Immunization Programs on CHIP-related initiatives.

City of Berkeley

The Alliance began to meet with the City of Berkeley in 2023 to explore collaboration on the CHA and shared objective. The Alliance plans to partner with the City of Berkeley to identify health and wellness needs for priority populations and enable training, screening, and referral pathways for City of Berkeley staff.

  • City of Berkeley Community Health Assessment (CHA) – Projected completion Fall 2024
  • City of Berkeley Community Health Improvement Plan (CHIP) – Projected completion 2025