6 Health Plan Quality Improvement Strategies

May 26, 2016


Bolstering health plan quality scores requires a health plan to be proactive and committed to increasing member engagement. Strategies for health plan quality improvement should focus on developing preventive health programs, early intervention screening programs and member education. Below are some key measures designed to raise a health plan’s quality scores.

Provide After Care Following Hospitalization  

Patients who are hospitalized with a serious health condition are at an increased risk for subsequent hospitalization. After care can be effective in mitigating this trend, making after care services an integral part of a patient’s discharge plan. An in-home health assessment following discharge is an effective means of identifying risk factors that could predispose a health plan member to re-hospitalization.

Screen Members for Osteoporosis  

Female members over the age of 65 are at a significantly greater risk for osteoporosis. Unfortunately, over thirty percent of osteoporosis cases never receive a diagnosis. Health plans can address this issue by identifying females over 65 who have suffered a recent fall or fracture and screening them for osteoporosis. This measure will improve your Osteoporosis Star Measure but  most importantly, help prevent future falls and fractures among members.  

Notify Members about Gaps in Care  

Health plans should have a process by which they remind members about preventive health screenings, vaccinations and medical appointments. Following the completion of a screening by a member, a health plan should ensure that members receive a reminder to schedule an appointment with their primary care physician. Reminders may be issued by telephone, e-mail or text.  

Educate Members Regarding Medication Management   

Chronically ill health plan members are more prone to medication-related problems than typical health plan members. Fortunately, the number of medication-related problems can be reduced through medication therapy management (MTM) and comprehensive medication review (CMR). These two strategies involve the use of counseling to educate health plan members about the proper use of medication. The end result is the desired combination of lower hospital readmission rates and higher rates of patient satisfaction.  

Identify High Risk Members for Special Engagement Services  

One of the greatest challenges facing health plans is the difficulty learning the profiles of high risk members. Many high risk plan members are opposed to visiting their primary care physician. Others refrain from participating in health risk assessments, making it impossible to develop a perspective on high risk members. Health plan officials can improve quality scores by implementing programs to engage their high risk members. The most effective programs involve the dispatch of a nurse practitioner or medical doctor to the home of high risk members. While this strategy involves the initial use of many health plan resources, the end result is a more engaged health plan member.  

Enhance Preventive Health Programs and Initiatives  

Preventive health programs demonstrate a health plan’s commitment to proactively improving the health of members. The use of health risk assessments and preventive health programs that target high risk plan members are two means of effectively leveraging programs. One such example is screening for depression among women who have recently given birth to a child. With postpartum depression affecting 10% to 15% of new mothers, the administration of early intervention screening activities can be instrumental in identifying and treating health problems before they result in a member’s hospitalization or death.


Fostering member engagement leads to higher quality scores. Preventive health programs, medication management education, early intervention screening activities and post-hospitalization follow up serve three valuable purposes. By engaging health plan members they:

  1. Improve the health of members
  2. Help provide long-term savings for a health plan
  3. Increase member satisfaction rates

These results are linked to high quality scores for health plans. Please contact us today to find out how we can help you raise your health plan’s quality scores.

Previous Article
Infographic: How Health Risk Assessments Improve Men's Health
Infographic: How Health Risk Assessments Improve Men's Health

In honor of Men's Health Month, take a look at how offering HRA's to your men member population may improve...

Next Article
5 Health Screening Services You Should Offer Your Members
5 Health Screening Services You Should Offer Your Members

5 health screening services health plans should offer their members


Request More Information

First Name
Last Name
Thank you!
Error - something went wrong!