Want to learn more about South Country's Quality Program?
The Quality Program at South Country is the framework that guides the formal process for evaluating and improving, where necessary, the quality and appropriateness of the health care services and the health status of the members we serve.
South Country has partnered with Sibley County on the development and implementation of a Community Health Worker. The Community Health Worker plays a significant role in Sibley County to address racial barriers, social inequities, and health disadvantages experienced by our Hispanic/Latinx members living there by working directly with that population.
The Sibley County Collaboration Group, made up of South Country staff and Sibley County Community Health Workers focus on initiatives to improve health outcomes for the Hispanic/Latinx community. Current initiatives include the translation of diabetic educational materials into Spanish; collaboration with the Hy-Vee dietician to offer a “virtual” store tour in Spanish for diabetics; and working to add more fitness centers to our list in the Sibley County communities for members to use their exercise benefit with.
Performance Improvement Projects:
Comprehensive Diabetic Care - for members on Senior Products (MSC+ and MSHO). This performance improvement project requires a focus on health disparities and is in place for calendar years 2021 – 2023. Our goal is to improve members self-management of their diabetes for those living in rural communities and experiencing geographic health disparities.
A Healthy Start for Mothers and Children – for members on PMAP and MinnesotaCare. This performance improvement project focuses on promoting a “Healthy Start” for our mothers and children while concentrating on improving services provided to pregnant women and infants, with a specific focus on reducing health disparities. Learn more here.
The Quality Program for South Country is the framework that guides the formal process for evaluating and improving, where necessary, the quality and appropriateness of health care services and the health status of the population South Country serves. South Country implements this Program through a collaborative effort between South Country staff, county Public Health and Human Services staff, and South Country’s Third-Party Administrators (TPAs).
The goals of South Country’s Quality Program are to: Establish effective partnerships with providers, primary care clinics, provider networks, and counties 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 all members regardless of race, ethnicity, geographic location have access to needed services and supports.
- Make certain 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; · Member and Provider Satisfaction;
- Access to care; and
- Service utilization.
Improve the clinical and functional outcomes of our members over time addressing the following domains of care:
- 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.
- Health Disparities
- Social Determinants of Health
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, grievances, and appeals;
- Analyzing satisfaction surveys on an on-going basis; and Ensure appropriate access by:
- Continue to expand 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.
- Education on Telehealth/Telemedicine services
- Addressing rural disparities
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.
South Country Health Alliance complies with the DHS enrollee satisfaction requirements through many different survey methods which look to identify any unmet health care needs, access issues, and overall enrollee satisfaction. South Country survey review is followed by implementation of any action plans needed to address specific issues identified in the survey.
Results of surveys are reviewed by management in the Health Services and Quality departments, as well as county staff including care coordinators, supervisors, and directors. Key findings are integrated into South Country’s Quality Improvement plan, so that activities supporting positive trends are maintained and areas of deficiencies are addressed.
Understanding the population we serve and the realities of the rural landscape are critical to minimizing barriers to care and finding solutions. The rural nature of our service area presents inherent challenges: access to care related to transportation; difficulty recruiting providers; and higher rates of poverty and negative social drivers of health. These challenges require us to help our members navigate and manage their care. South Country is best equipped in helping members overcome these obstacles to better health through innovation and collaboration.
South Country employs Care Connectors in each of our service area counties with the purpose of improving members’ experiences getting their healthcare. The Care Connector works closely with South Country staff to link members with customized support for improved health outcomes.
The majority of our staff live within our service area and understand our rural communities’ unique perspective. This insight is especially valuable with designing and implementing new benefits and requirements by allowing us to overcome potential barriers and unintended consequences.
The Quality Program’s goals and objectives criteria, activities outlined in the Quality Program Description, and the Quality Work Plan for the previous year are evaluated for appropriateness and effectiveness in assessing and improving the quality of care and services members receive. The quality committee structure is continually being evaluated and adjusted as needed.
The full annual evaluation (links are on the right) goes into detail on each of our Quality Improvement Program areas showing where we demonstrate the progress of our programs that meet and exceed network-wide safe clinical practices. See the 2021 Quality Evaluation here (pdf)
Quality Program Documents
Learn more about how Quality Improvement works at South Country Health Alliance in the documents below.