Quality Improvement Program

CeltiCare Heath Quality Improvement (QI) Program focuses on preventive health. The program creates plans, puts those plans into action, and measures efforts to improve your health and safety. 

The QI Program strives to make a difference in health outcomes. It develops actions to improve member and provider satisfaction. CeltiCare Heath involves providers within our plan. The providers assist with developing and monitoring activities of the QI Program as well as providing insight into preventive health resources and information.

For questions about the QI Program and our progress on meeting goals, call the Member Services department at 1-866-769-3085 (TDD/TTY 1-855-742-0123).

The QI Program also reviews services provided to our members. We have clinical practice guidelines for certain conditions. If you would like a copy of these guidelines or need more information about programs call us at 1-866-769-3085 (TDD/TTY 1-855-742-0123).

Information and/or a full copy of CeltiCare Heath’s current QI Program Description is available upon request.

Quality Improvement Program Updates - 2016

CeltiCare Health cares about you and the healthcare you receive. In 2016, we completed many quality improvement projects to help us see if our members are completing their recommended care and if our participating providers are giving the recommended services to our members.

HEDIS® (Healthcare Effectiveness Data and Information Set) is a tool that helps us make sure our members are getting the care they need. We compare our results to the same results of other health insurance plans. Every year we like to share some of the quality improvement efforts and the results of our HEDIS monitoring with you and let you know what we’re doing to improve the health of our members.

We help our members get their recommended preventive exams and recommended medical care for chronic conditions.  We also remind our participating providers that their patients are due or past due for their recommended screenings. In 2016, if you were past due for a service you and/or your doctor may have received one of our educational letters or calls to remind you about checkups you should have.  Our outreach programs help you be the healthiest you can be.

In 2016 CeltiCare Health completed member and provider focused improvement interventions in the following areas:

  • Breast Cancer Screening
  • Chlamydia Screening
  • Cervical Cancer Screening
  • Comprehensive Diabetes Care
  • Anti- Depressant Medication Management
  • Controlling High Blood Pressure

CeltiCare Health continuously assesses our successes and opportunities for improvement and every year we look at our final results and select the HEDIS Measures that need improvement for the following year.

The tables below will show some of our 2016 quality improvement successes and some of our opportunities for improvement for 2017.

2016 Quality Improvement Highlights

HEDIS MEASURE

2014

2015

2016

BENCHMARK ACHIEVED

Adult BMI Assessment (ABA)

80.95%

80.71% (↓)

86.81% (↑)

50th

Controlling High Blood Pressure (CBP)

56.15%

59.07% (↑)

67.56% (↑)

75th

Initiation and Engagement of AOD Dependence Treatment: Engagement (IET)

17.33%

16.93% (↓)

16.96% (↑)

90th

Pharmacotherapy Management of COPD Exacerbation: Systemic Corticosteroid (PCE)

75.00%

71.11% (↑)

80.85% (↑)

90th

* National Medicaid Quality Compass Benchmark- Measurement Year 2015

2016 Quality Improvement Opportunities for Improvement

HEDIS MEASURE

2014

2015

2016

BENCHMARK ACHIEVED*

Antidepressant Medication Management: Acute Phase (AMM)

44.21%

43.88% (↓)

47.56% (↑)

10th

Antidepressant Medication Management: Continuation Phase (AMM)

30.99%

29.69% (↓)

31.16% (↑)

10th

Cervical Cancer Screening (CCS)

40.57%

41.59% (↑)

44.68% (↑)

10th

Follow-Up After Hospitalization for Mental Illness: 30 Day Follow-Up (FUH)

67.30%

70.87% (↑)

62.69% (↓)

33.33th

* National Medicaid Quality Compass Benchmark- Measurement Year 2015

At CeltiCare Health, your health means the world to us. As you can see, we are working hard to make sure you get the best care you need, when you need it. We are always trying to improve and your comments are important to us. CeltiCare Health created a Member Advisory Council so we could get and use your feedback.

Please call Member Services or visit our ‘Contact Us’ page on the website to tell us how we can better serve you. You can also tell us if you would like to become a member of the Member Advisory Council. We want to hear from you.

Call Member Services at 855-678-6975 (TDD/TTY: 1-866-614-1949.)