Our Quality Commitment

We want to exceed your expectations

The ways we measure quality and keep improving the member experience

Health Tradition Health Plan is continuously working to provide a level of service consistent with the high standards of quality care established by Mayo Clinic Health System. We advance our vision of service to our members in the following ways:

  • We participate in formal programs that measure and report our performance in areas identified as key quality metrics.
  • We are accredited by an independent organization with extensive quality criteria, a rigorous accreditation process and recurrent reaccreditation requirements.
  • We are measured by governmental agencies to gauge achievement of targeted public health objectives within our member population.

URAC accreditation

In 2013, Health Tradition Health Plan was awarded Health Plan Accreditation by URAC, the largest independent accrediting body for health care organizations, after an extensive study of the company’s operations.

URAC accreditation is a dynamic process that identifies best practices and promotes high quality performance measures. Organizations that seek to earn accreditation demonstrate their commitment to quality, accountability and customer service, voluntarily undergoing a rigorous and periodic review that evaluates their operations and services. Health plans that earn URAC accreditation are among the best in the nation.

Specifically, URAC’s measures address the following key areas aimed at helping plans deliver safe, high-quality, patient centered, high-value care:

  • Wellness and Health Promotion
  • Care Coordination
  • Medication Safety and Care Compliance
  • Rewarding Quality
  • Care Delivery through a Patient Centered Health Care Home Network
  • Mental Health Parity
  • HIPAA Breach Requirements
  • Measures — patient centeredness, coordination of care, patient safety, health plan administration, efficiency, effectiveness of care and HIT integration
  • Patient Experience of Care (CAHPS® Survey)
  • Operational efficiency and quality in administering members’ benefits

The BadgerCare Plus HMO Report Card, Wisconsin Department of Health Services (DHS)

Health Tradition Health Plan and other HMOs are graded annually for care provided to members enrolled in BadgerCare Plus, a Medicaid program administered by the State of Wisconsin. Grades are awarded by the Wisconsin Department of Health Services (DHS) as part of The BadgerCare Plus HMO Report Card.

In the Aprll, 2013 report card, Health Tradition Health Plan was the only health plan in the state to earn an “A” grade for its performance in each of the seven individual measures. In all, sixteen health plans across Wisconsin were rated. Each was held accountable for care categories including treatment of asthma and diabetes, vaccinations, blood lead testing and smoking cessation.

The BadgerCare Plus HMO Report Card is issued annually by the Wisconsin Department of Health Services. It guides BadgerCare-eligible residents in selecting the plan that best supports their health.

HEDIS® reporting

This reporting program is called the Healthcare Effectiveness Data and Information Set or HEDIS.® HEDIS provides unbiased quality information. More than 90 percent of health plans across the United States participate in their data collection. We are excited to report that Health Tradition exceeded the HEDIS 2013 National Committee on Quality Assurance (NCQA) national rate in the following measures:

  • Childhood Immunizations Status: DTaP/DT, IPV/OPV, MMR, Hepatitis A, Rotavirus, Hepatits B, Influenza, HIB, Pneumococcal Conjugate and Combo 2 (DTaP, IPV, MMR, HiB, Hepatitis B, Varicella)
  • Timeliness of Prenatal Care and Postpartum Care
  • Cholesterol Management for Patients with Cardiovascular Conditions
  • Breast Cancer Screening
  • Colorectal Cancer Screening
  • Comprehensive Diabetes Care: HbA1c Testing, HbA1c <8%, Eye Exams,
    LDL-C Level <100, Nephropathy Monitoring, BP <130/80
  • Controlling High Blood Pressure <140/90
  • Adolescent Immunizations: Tdap/Td and Meningococcal
  • Antidepressant Medication Management: Effective Acute Phase Treatment, Effective Continuation Phase Treatment

CAHPS® Member Satisfaction Survey

Today’s complex and competitive healthcare environment has generated unprecedented demand for tools and information to document healthcare quality. The consumer’s perspective has become an essential aspect of measuring healthcare quality, and CAHPS® Member Satisfaction Survey is recognized as the industry standard for obtaining consumers’ assessment of their health plans. Health Tradition Health Plan contracts with an NCQA-accredited company to conduct our CAHPS® survey annually.

Organized Health Care Arrangement (OHCA)

As an ongoing effort to improve the quality of care and reduce costs for patients, Mayo Clinic Health System – Eau Claire, Mayo Clinic Health System – Franciscan Healthcare and Health Tradition Health Plan have formed an Organized Health Care Arrangement (OHCA) agreement.

An OHCA gives separate organizations serving the same patient the ability to cooperate by sharing medical information. Sharing this information enables us to

  • Proactively improve the quality of care
  • Control medical costs
  • Increase efficiency, promptness and accuracy
  • Develop new patient care and community health programs
  • Identify at-risk patients so they receive appropriate care
  • Provide more responsive, personalized care for specific health situations
  • Measure many aspects of care delivery for quality assessment and improvement purposes

An OHCA provides a formal structure for the Mayo Clinic Health System practices and Health Tradition to share Protected Health Information (PHI) in compliance with HIPAA privacy rules. Under the OHCA, Health Tradition also authorizes Mayo Clinic Health Solutions, Health Tradition’s third party administrator (TPA), to share member claims data such as diagnostic and service codes, dates of service, and billing—the type of information shown on an insurance Explanation of Benefits (EOB). It does not allow sharing any notes recorded as part of a provider visit.

This OHCA partnership builds on the cooperation that already occurs within the organizations for the benefit of patients and plan members.

 

Health Tradition Health Plan does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.