Monitoring Quality Management

QM Program

Our goal at America’s 1st Choice (SC HMO) is to help our members improve their health by providing the best care and service options. In order to do this, we rely on our Quality Management (QM) program. The QM program monitors the quality of care given by Plan providers. The QM Program also looks for areas of service that need to be improved.

Measuring Success

Every year, we measure to see the progress we have made toward meeting our goals for healthy members. One of the tools we use to do this is called HEDIS®, which stands for Healthcare Effectiveness Data and Information Set. HEDIS® is a very common tool used by health care plans to see how well they are serving their members. We use these HEDIS® results to see where we need to focus our improvement efforts.

HEDIS® Results

Our 2019 HEDIS® (DOS 2018) results show that America’s 1st Choice (SC HMO) met our quality goals in many HEDIS® measures. These areas include:

  • Adult Access to Preventive Services
  • Adult BMI Assessment
  • CDC: Good HbA1c Control (< 8), HbA1c Testing and Diabetic Nephropathy
  • Use of High-Risk medications in the Elderly - one script
  • Pharmacotherapy Management of COPD- Systemic Corticosteroid
  • Spirometry Testing

Areas where we would like to improve our performance include:

  • Breast Cancer Screening
  • Controlling High Blood Pressure
  • CDC: Poor HbA1c Control (> 9), BP Controlled < 140/90 and Eye Exams
  • Colorectal Cancer Screening
  • Use of High-Risk Medications in the Elderly - Two scripts
  • Medication Reconciliation Post- Discharge
  • Pharmacotherapy Management of COPD- Bronchodilator

You can view our full quality Health Plan Report Card at: https://reportcards.ncqa.org/#/health-plans/list

For more information on HEDIS® and Quality Measurement, go to
http://www.ncqa.org/HEDISQualityMeasurement.aspx

You can also call Member Services at 1-888-563-3289.

Last updated 10/01/2019