Provider : Quality

Patient safety is your main concern and ours.  This is often complex as patients have multiple providers caring for them, especially those with chronic behavioral health and/or physical health issues.  The Improving Chronic Illness Care (ICIC) , supported by the Robert J Wood Foundation, provides information to assist helping the chronically ill through quality improvement and research.  If you have a patient whose care is complex and/or chronic, please partner with our Case Management staff to help keep care coordinated and safe.  For more information on our Case Management programs and how to contact, refer to the Provider Manual. 

Meaningful Use

Today's providers need to focus on efficient and effective care through population management, disease management, e-prescribing and other tools available through Electronic Health Records (EHR).  CMS has established a program to assist providers in this process, allowing refunds for meeting certain performance requirements and showing "meaningful use" of their system.  Assistance is available through the Regional Extension Centers (RECs) and Better Health Greater Cleveland. 

Patient-Centered Medical Home

Quality is more than documentation.  CMS and the ODJFS are encouraging providers to become active care managers and coordinators by becoming a Patient-Centered Medical Home (PCMH).  We are here to help you become a certified PCMH.  Feel free to access the documents and links provided to identify how these programs will work in your organization:

Board Certification - Several Medical Certification Boards are now requiring providers to complete a quality improvement project as part of their renewal process.  Protect™, a multi-organizational educational initiative, provides more information.   If you are a PCP, OB or a Pediatrician, we can help you identify resources and provide data for you to complete this requirement.  Please call the WellCare office at 216-901-4118, request the Department of Quality for quality assistance.  Addtionally these links may be useful to you:

Quality Improvement Skills Modules - The Healthcare Improvement Skills Center is a web based resource that features highly interactive and well regarded case driven QI skills web modules that enable you to learn about quality improvement at your own pace.   If you complete all activities
you can earns 25 hours of CME credit (other options are available). These modules prepare you for systematic quality efforts now routine in most healthcare systems and required by the Joint Commission, the 24 American Board of Medical Specialties (ABMS) affiliated boards, and the American Council on Graduate Medical Education (ACGME) in all residency and fellowship programs. 
 

Care Transitions - Everyone in health care tries to give patients the best possible care but we all recognize the dangers of transitions - those times when the patient is moving from one source of care to another.  The Care Transitions Program® and The National Coordinating Center (NCC) for the Integrating Care for Populations and Communities Aim (ICPCA) both provide multi-dimensional programs to improve care transitions.

HEDIS and other required chart abstractions - The Department of Quality is very grateful for your cooperation in the various mandatory chart audits and reviews.  Many of these are required by CMS, ODJFS or NCQA.  Our goals for all our reviews and audits is to continually improve our processes to reduce burden, provide real time feedback with concrete recommendations and accuracy.  Again, thank you.  Feel free to contact us at 216-901-4118.

Cultural Competency - WellCare offers a Cultural Competency training that may be accessed by web-registered providers.  Not registered for our secure log-in?  Sign up today!  The Management Sciences for Health (MSH) also provides a website designed for health care organizations and providers in providing high quality, culturally competent services to multi-ethic populations. 

Provider Resources

• BMI Patient Progress Chart Note
• Maternity Education Booklet
• Provider HEDIS® Toolkit

Member Resources

• text4baby program flyer