To achieve objectives, performance-improvement projects must be designed, conducted and reported in a methodologically sound manner. Health Care Excel conducts quality-review activities to assess a health plan’s methodology for conducting a performance improvement project, verifies actual study findings, and evaluates the overall validity and reliability of the study results.
Health Care Excel analyzes the health plan’s accuracy of reported performance measures and adherence to established federal and state specifications. This review includes an evaluation of the process the health plan used to produce its performance measures.
Health Care Excel conducts compliance reviews of health plans to determine the quality, timeliness of and access to care and service provided to the plans’ members. Performance is assessed with regard to regulatory provisions and operational areas. We work closely with the plans during this process to ensure that an accurate evaluation is completed.
We have extensive experience with all components of compliance-review activities, including pre-onsite document review, onsite reviews, staff interviews, development of corrective-action plans, follow-up review activities to determine compliance with the corrective plans and preparation of required reports to the state agency.