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If you want to focus on quality of care to members, first consider the concept of population health, rather than individual health, Dennis Scanlon PhD, says.
When it comes to common things that afflict many members, it’s best not to develop one-on-one quality improvement plans, but initiatives that are based on a larger population, says Scanlon, assistant professor of health policy and administration at Pennsylvania State University and lead author of a study on managed care plans and their use of performance measures in quality improvement plans.
Here are the steps he suggests:
Whether you deal with Medicare, Medicaid, or commercially insured populations, your members are likely to have varying needs based on your particular geographic location and the demographics of your population base.
"There is always diabetes and asthma, but in some areas, the focus may be a little different from others," he adds.
For instance, if most of your members are Medicare recipients, you probably don’t need to focus on childhood immunizations.
One of the advantages of data sets is that they allow you to benchmark against other organizations to see where you fall short. "Part of the process is to recognize your current level of performance," he says.
"The idea is to decided what wars you’re going to wage," he says.
Once your areas of focus are chosen, look for models that may have been developed by other organizations. Research what works and doesn’t work.
"There are a lot of opportunities to learn what others are doing and assess what you are doing relative to that," he says.