South Carolina Quality Achievement Program
Since 2022, the Quality Achievement Program has worked to improve outcomes for Healthy Connections enrollees.
Targeting Outcomes
The Quality Achievement Program (“QAP”) is a collaboration between Managed Care Organizations (“MCOs”) and South Carolina hospitals that aims to improve health outcomes for Healthy Connections enrollees (“Members”).
Current Projects
Current improvement efforts are focused on six distinct project areas.
Hypertension
Over 37% of South Carolinians have hypertension.
The Hypertension project aims to increase blood pressure control among Members.
Diabetes
South Carolina has a diabetes diagnosis rate 12% higher than the national average.
The Diabetes project works to increase HbA1c and blood pressure control among diabetic Members.
ED Utilization
When controlled for population, South Carolina outpaces most other states in emergency room visits.
The ED Utilization project seeks to reduce unnecessary ED visits through navigation of Members to appropriate outpatient care.
Maternal Care
South Carolina’s preterm and low weight birth rates are among the highest in the country.
The Maternal Care project works to reduce preterm births, low weight births, and elective deliveries.
Health Equity
Across all races, South Carolina’s health equity measures lag behind national averages.
The Health Equity project works to increase screening and intervention for social determinants of health, including unmet food, transportation, and housing needs.
Healthy Lifestyle
South Carolina has an obesity rate of 35%.
The Healthy Lifestyle project seeks to encourage active lifestyles and healthy dietary choices through BMI assessments, education, and counseling.
To enhance Member health outcomes, projects adopt multifaceted approaches that address various components of healthcare delivery. This comprehensive strategy applies to each project’s distinct focus and includes:
Monitoring Outcomes
Data Collection & Analysis
Provider Engagement
Member Engagement
Member Engagement
The Quality Achievement Program has made significant strides in improving outreach and engagement with South Carolina’s most vulnerable populations.
Member engagement is a central component of each project, with milestones focused on educating Members, conducting focused follow-up, and assisting Members in utilizing healthcare resources.
Projects are structured with Member outreach as a central aspect.
The format of the diabetes project has made it easier to monitor Members with uncontrolled HbA1c and bring them back in for care.
Each project includes opportunities for Network Providers to share best practices for Member outreach.
Learning how other Network Providers work with Members validates the work we’re doing.
Focus on Member outreach is closing communication gaps.
Our hospital has realized one of the biggest barriers to care is incorrect Member information, including incorrect phone numbers. Our staff has benefited from the additional focus on gathering up-to-date contact information.
Projects enable continuous outreach.
The ED project has allowed us to have dedicated staff resources devoted to continuous Member outreach.
Provider Engagement
Provider engagement is at the core of project efforts. Prioritizing provider input ensures that project goals are both achievable and impactful. Engagement also includes equipping providers with the tools and knowledge necessary to drive meaningful change.
We have appreciated the monthly meetings as well as the in-person session to get to know the teams at other organizations. We’ve had good results with information outside of those meetings as well.
Each project typically provides the following opportunities for provider engagement:
- Feedback on project materials sought and incorporated.
- Meeting to address any issues with project implementation.
- Annual continuous quality improvement meetings to discuss lessons learned and areas for improvement.
- Selection and implementation of activities designed to address project-specific root causes.
- Training on data entry and reporting requirements.
- Provider education regarding project initiatives.
- Monthly calls with all network providers to discuss project implementation and program updates.
- Annual in-person collaborative meeting with all network providers, MCOs, and DHHS.
Data Collection & Analysis
- Data collection and analysis is an integral part of each project and allows a comprehensive view of Member health outcomes and improvements.
- MCOs collect data related to certain project metrics from Member encounters at participating hospitals.
- Data is analyzed and used to measure the effectiveness of interventions, identify trends, and inform decision-making.
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The Quality Achievement Program has allowed our rural hospital to start collecting information on social determinants of health. This allows clinicians to more easily assist Members in overcoming these barriers to care.
-Network Provider
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Monitoring Outcomes
The ultimate goal of the program is to improve health outcomes for Members across South Carolina. To track progress toward these goals, data submitted by participating hospitals is used to establish baseline data. In future program years, data submitted will be compared to baselines and project-specific goals.
Monitoring project success allows the program to celebrate realized successes and pivot approaches as needed to ensure continual progress.
Monitoring outcomes allows participating hospitals and MCOs to track improvements made across various project metrics. Hospitals have shared the following feedback regarding outcome monitoring efforts:
Changes implemented through these projects are effective in helping patients acquire the resources needed to make behavior changes that will help manage their conditions.
Participation in the program has allowed us to provide additional guidance, support, and external resources to Members.
Project Milestones by Year
Project efforts are focused on achieving specific, individual milestones related to each project.
Diabetes | Hypertension | ED Utilization | Maternal Care | Health Equity | |
|---|---|---|---|---|---|
Year 1 | 7 | 6 | 7 | 6 | - |
Year 2 | 10 | 6 | 9 | 8 | 6 |
Year 3 | 10 | 6 | 9 | 8 | 9 |
Project Milestones
More details on each project’s milestones are available at the following links: