The purpose of the Quality Improvement (QI) Program is to support L.A. Care’s mission through the development and maintenance of a quality-driven network of care for all lines of business. 

The QI program strives to improve quality of care and service to members and to support the provider-patient relationship.  The health and wellness of our members is maintained through the delivery of coordinated, comprehensive, quality health care.

Network practitioners play a prominent role in the QI Program.  L.A. Care actively solicits practitioners to become involved in QI activities through participation on QI, Credentialing, and Utilization Management committees, expert participation in peer review, and other collaborative activities.

The QI program is an evolving program that is responsive to the changing needs of our members and providers.  L.A. Care annually assesses its QI program to identify opportunities for improvement, implement appropriate interventions, and assist you in improving your patients’ health. 

Below are some highlights of QI activities designed to evaluate and improve the quality of health care for members:

Health Plan Employer Data Information Set (HEDIS)

Every year, L.A. Care participates in an annual audit of HEDIS measures.  HEDIS is a standardized set of performance measures designed to facilitate comparisons of health plan access, effectiveness, administration, and performance related to a variety of routine health service indicators. 

The table below compares HEDIS rates for 2006 and 2007 against the goal in 2007.

L.A. Care has developed and implemented a number of interventions over the last year to continue improving HEDIS measures. Some of these activities include:

·         Enhancement of the member and provider incentive program for the well child measures.

·         Introduction of the perinatal incentive program for members and providers.

·         Contracting with March Outreach Services to help members schedule a diabetes visit with their PCP and an eye exam with a vision provider in an effort to improve screening rates for diabetes measures.

·         Implementing the Asthma Improvement Project to work with providers with a high volume of asthma patients to improve quality of care.

·         Development and distribution of the asthma tool kit, chlamydia care guide, and obesity tool kit. 

Statistically significant improvements (α=0.05) between HEDIS 2005 and HEDIS 2006 were achieved for Childhood Immunizations (combination two) (p<0.0001), Chlamydia Screenings 16-25 years (p<0.0001), and Appropriate Medications for People with Asthma (p<0.0001).  No statistically significant decreases were observed for the 10 key measures. 

Member Satisfaction Survey

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey was conducted for adults, children, and children with chronic conditions in 2006.  Results showed that improvements had been made from 2004 to 2006 for two areas including:

·         In 2006, 62.9% of respondents said “seeing a specialist” was not a problem compared to 55.9% in 2004

·         In 2006, 87.2% of respondents said “delays in health care while waiting for health plan approval” was not a problem compared to 80.3% in 2004

Key findings also suggested that L.A. Care should focus improvement efforts on “getting needed help quickly” and “courteous office (physician) staff.”  L.A. Care is implementing interventions to address these findings, including conducting training programs on customer service for office staff.

Provider Satisfaction with the Utilization Management Process

A provider satisfaction survey was conducted in 2006 to measure satisfaction with L.A. Care’s utilization management processes.  The study indicated that a majority of providers (primary care and specialty care) are satisfied with timely decisions, timely appointments, and clinically reasonable decisions (provider satisfaction ranged between 61%–71%).

Asthma Disease Management Program

L.A. Care implemented an asthma disease management program for its Healthy Families, Healthy Kids, and Medi-Cal Direct members.  As a part of this program, L.A. Care sends quarterly asthma reports -- along with asthma care reminders -- to all providers with asthma members.  L.A. Care also sends member educational materials to all members enrolled in the asthma disease management program.  In addition to the educational materials, high risk members receive a phone call and/or home visit by an asthma care manager to help them better manage their condition.  L.A. Care also sponsored an asthma camp with the Painted Turtle organization in 2006.  In fall of 2007, L.A Care will sponsor two more asthma camps with the same organization.  

Continuity of Care

The QI program is committed to ensuring mechanisms that support continuity of care are in place for members.  A study of providers indicated that 62% of primary care providers were satisfied with coordination of inpatient care, while only 33% of primary care providers and specialty care providers said they received information “always” and “often” from the hospital after their patient was discharged.  

Opportunities for improvement were identified in the areas of educating providers and hospitals on the importance of follow up and how it can improve quality of care.  L.A. Care has included educational materials in the provider newsletter on the importance and relevance of continuity of care.  L.A Care will be addressing these issues at different committee meetings that involve physicians and their office staff. 

Access to Care

In 2006, a comprehensive Access to Care Study was conducted to assess members’ access to medical care and to measure the compliance of contracted physicians in rendering medical care within timeframes established by L.A. Care and the California Department of Health Care Services (DHCS). 

Opportunities for improvement were identified in the areas of appointments for selected pediatric sub-specialties and coordination of after hours medical services. 

Across all specialty types, there was an average wait of 14.6 days for a routine care visit with a Medi-Cal specialist, which is far below the 30 day standard set by DHCS.  This represents a marginal increase over results of the 2005 study, where an average of 13.9 wait-days was reported.  Pediatric sub-specialties reported higher average appointment wait-days (22.9 wait-days) when compared with non-pediatric specialties (13.9 wait-days).  However, when compared to the results of the 2005 study, there were decreased wait-days for Pediatric Cardiology, Pediatric Endocrinology, Pediatric Hematology-Oncology, Pediatric Nephrology, Pediatric Pulmonary, Pediatric Orthopedics and Pediatric Neurology. Member satisfaction also showed an improvement in seeing specialists. L.A. Care will continue to developing interventions to ensure that any willing and qualified specialist is contracted.

Bridging Cultural Gaps in Care

In 2006, L.A. Care was awarded the prestigious “Recognizing Innovation in Multicultural Health Care Award” by the National Committee for Quality Assurance (NCQA) for its efforts in reaching across cultural divides to address obesity inLos Angeles County.  L.A. Care’s pediatric weight management toolkit is a comprehensive guide to help health care providers understand how to treat obesity and has been cited as a national model for plans to follow on how to bridge language and cultural gaps in health care.

Patient Safety

L.A. Care is committed to improving patient safety and promoting a supportive environment for network physicians and other providers to improve patient safety in their practices. 

Information about safety issues is received from multiple sources, including member and practitioner grievances, adverse issues, pharmacy data such as polypharmacy, facility site reviews, continuity of care activities, member satisfaction survey results and Leapfrog survey results.  Many of the ongoing QI Program measurement activities, including measures for accessibility, availability, adherence to clinical practice guidelines and medical record documentation, include safety components.  When performance is analyzed for these measures, patient safety is considered, opportunities are identified and prioritized and actions taken to improve safety.

Pharmacy safety measures include edits at the point of service.  Each prescription filled is subject to a prospective drug utilization review.  This review includes a search for possible drug interactions and previous known allergies to reduce the risk of dispensing medications with potential adverse consequences. 

Additionally, pilot programs have been initiated to assess the role of e-prescribing to reduce medication errors and improve patient safety, distribute pre-printed prescription pads, and a pilot providing ePocrates to safety net clinicians to assess the effect of providing access to a drug database and formulary resource.  L.A. Care has also initiated a hospital incentive program that rewards hospitals for reporting data to organizations like Leapfrog and CHART.

L.A. Care values the opinion of both its members and providers.  Our commitment is to you.  If you have questions about our Quality Improvement Programs or if you would like further information or a paper copy of this information, please write us at:

L.A. Care Health Plan

555 West 5^th Street, 29^th Floor

Los Angeles, CA  90013

Attn:  Quality Improvement Department