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South Country Health Alliance | Quality Program

Quality Program

Background

South Country Health Alliance was founded by a group of counties with a common vision that rural communities benefit when health care is locally governed, organized, and delivered. The current eight counties that own South Country Health Alliance continue to share in that promise to build healthier rural communities using local health care resources and talents.

The Joint Powers Board, partnering county agencies, administrative personnel, and network providers are committed to delivering efficient and effective services in a manner that continuously improves the quality of care and the health status of members. This is achieved through a care management and service delivery model that is integrated in partnership with local county-based health and human service resources; it incorporates medical, public health and social services, and enables South Country Health Alliance’s members to receive services in a comprehensive and cohesive manner.

Goals

South Country Health Alliance’s Quality Program is the framework that guides the formal process for evaluating and improving the quality and appropriateness of health care services and the health status of our members. The goals of our Quality Program include:

Establish effective partnerships with providers, primary care clinics, and provider networks committed to quality care; to accomplish this, South Country will:

  • Collaborate with providers and county Public Health and Human Services agencies to share ideas and implement strategies to improve quality;
  • Ensure that South Country and TPA provider contracts reflect mutual expectations of quality initiatives;
  • Monitor South Country’s and TPA’s credentialing and re-credentialing processes to ensure quality standards are maintained by providers; and
  • Recruit additional providers when gaps in the network are identified to ensure members have access to quality providers and to offer more choices whenever possible.

Establish and measure performance expectations that include:

  • Clinical outcomes and clinical processes;
  • Functional outcomes;
  • Satisfaction;
  • Access; and
  • Service utilization.

Improve the clinical and functional outcomes of our members over time addressing the following domains of care:

  • Prevention;
  • Acute care;
  • Chronic illness care;
  • Behavioral health care;
  • Special population needs;
  • High-volume services;
  • High-risk services;
  • Continuity and coordination of care;
  • Access to quality community-based behavioral health and support services; and
  • Patient safety.

 Improve member satisfaction and South Country’s understanding of which factors contribute to satisfaction by:

  • Addressing processes and/or underlying issues identified through analysis of complaints, appeals, and grievances;
  • Analyzing satisfaction surveys on an on-going basis; and
  • Implementing population health programs that improve the quality of life of our members.

Ensure appropriate access by:

  • Expanding community relationships;
  • Assessing and improving culturally and linguistically competent services;
  • Promoting efficient and appropriate use of health care resources;
  • Understanding patterns of service utilization;
  • Decreasing unnecessary variation in use; and
  • Exploring non-traditional resources, services, and settings for care.

 Meet regulatory requirements such as:

  • Requirements for quality activities and set by South Country’s governing agencies;
  • Rules and regulations of Minnesota Department of Health (MDH), Centers for Medicaid and Medicare Services (CMS), and Minnesota Department of Human Services (DHS) contract requirements;
  • NCQA Quality Management and Improvement Standards; and
  • Public health goals for the State of Minnesota.

Accessing input and resources from the specialists in member-counties rests at South Country Health Alliance’s core. Essentially everything important we do, including quality improvement work, is done from the “county perspective” and in most cases the operational models use local county resources and county staff.

South Country Health Alliance understands and embodies the value of working with local communities to improve health and health care. This attitude and approach has evolved over time; we are an accountable, locally based entity focused on improving rural health care. True to our mission, we remain committed to delivering efficient and effective local health care in a manner that supports and improves the well-being of our members.