Quality Care and Patient Safety

 

Group Health Cooperative of Eau Claire is committed to providing our members quality care and ensuring patient safety. Patient safety is a fundamental principle of health care. Prioritizing the safety of patients results in reduced risks and harm, better health outcomes, enhanced patient experiences, and lower costs.

“What Are We Doing to Promote Quality Care and Patient Safety?”

Credentialing and Provider Relations -
Using NCQA specifications, we thoroughly screen health care providers when they apply to be part of our network to maintain quality of service to members. Then we continually check to make sure they maintain their professional credentials and quality. Site visits and facility audits are performed by a Quality Improvement Specialist to assure that providers are consistently providing the highest possible quality of care.

Rapidly Evolving Medical Advances -
We evaluate new technology in medical care and treatment on a regular basis to determine when new services should be covered. Group Health Cooperative of Eau Claire medical experts review information from government health agencies and scientific publications. We also get input from providers who offer the service.

Continuous Improvement and Reporting -
Group Health Cooperative of Eau Claire uses resources such as the Healthcare Effectiveness Data and Information Set (HEDIS) provided by the National Committee for Quality Assurance (NCQA) to improve health care outcomes for our members. HEDIS is one of the most widely used sets of health care performance measures in the United States.
 

Clinical Practice Guidelines

Group Health Cooperative of Eau Claire recommends the following toolkit and/or clinical practice guidelines for providing care to our members

Continuity and Coordination of Care

The Cooperative’s goal is to improve continuity and coordination of care for its members to reduce the risk of problems when members see multiple providers in different health care settings. We collaborate with our providers to identify and implement opportunities to facilitate continuity and coordination of care and ensure mechanisms are in place for timely and confidential exchange of health information between behavioral health providers and primary care providers, specialists, and health care delivery systems. We encourage our providers to use the following resources to ensure continuity and coordination of care for our members.

HealthCheck

Preventive Health Care for Children and Young Adults Through Age 20. The HealthCheck benefit helps children and young adults stay healthy

  • HealthCheck is a Medicaid health care benefit especially created for young people.

  • HealthCheck covers in-depth exams and checkups. It also covers specialized services or products your child may need under HealthCheck "Other Services."

  • Anyone under 21 who has Medicaid, BadgerCare Plus, or a ForwardHealth card is automatically covered. There are no forms to fill out.

  • During a HealthCheck well-child exam, all parts of the child’s health and development are looked at.

  • The goal of HealthCheck is to prevent illnesses and find and treat health issues early.

  • This benefit is called EPSDT (Early and Periodic Screening, Diagnosis, and Treatment) in federal Medicaid publications.

  • To be considered a comprehensive HealthCheck screen, the provider must conduct and document the following assessments:

    • A complete health and developmental history (including anticipatory guidance).

    • A comprehensive unclothed physical examination.

    • An age-appropriate vision screening exam.

    • An age-appropriate hearing screening exam.

    • An oral assessment plus referral to a dentist beginning at one year of age.

    • The appropriate immunizations (according to age and health history).

    • The appropriate laboratory tests

      • Including blood lead level testing for children younger than 2 years of age.
         

Resources

The following resources provide information that can help promote quality and patient safety. Group Health Cooperative of Eau Claire encourages all participating providers to be actively involved in patient safety practices and quality improvement. Standards designed by the health care industry and patient safety groups holds both health care professionals and patients accountable for patient safety.

  • Wisconsin Collaborative for Healthcare Quality
    The Wisconsin Collaborative for Healthcare Quality (WCHQ) publicly reports and brings meaning to performance measurement information that improves the quality and affordability of health care in Wisconsin, in turn improving the health of individuals and communities.

  • The Leapfrog Group
    The Leapfrog Group collect, analyze, and publish data on safety and quality to push the health care industry forward. Leapfrog promotes high-value care and informed health care decisions.

  • Wisconsin Hospital Association
    Advocate. Advance. Lead. It’s what the Wisconsin Hospital Association (WHA) does for its member hospitals and health systems so they can provide high-quality, affordable, accessible health care for Wisconsin families and communities.

  • Institute for Healthcare Improvement – Triple Aim

    The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:

    • Improving the patient experience of care (including quality and satisfaction);

    • Improving the health of populations; and

    • Reducing the per capita cost of health care.

    The organization helps provide training for health care providers in order to improve the health care of individuals and populations.

  • Hospital Compare Database
    This website displays hospital performance data in a consistent, unified manner to ensure the availability of credible information about the care delivered in the nation’s hospitals

  • Agency for Healthcare Research and Quality
    The Agency for Healthcare Research and Quality (AHRQ) is the lead Federal agency charged with improving the safety and quality of America's health care system. AHRQ develops the knowledge, tools, and data needed to improve the health care system and help Americans, health care professionals, and policymakers make informed health decisions.