Quality Care and Patient Safety
HPI is committed to providing you with available resources that can help you make informed decisions purchasing healthcare.
What is quality health care?
Quality health care means doing the right thing, at the right time, in the right way, for the right person and having the best possible results.
There are important differences in the quality of care delivered by physicians and hospitals in different parts of the United States.
What do most consumers look for in quality?
- The basics: Cost, coverage and access to services
- Staying healthy: Help with preventing illness and complications of disease
- Getting better: Testing and treatment for short-term, acute illness
- Living with illness: Reducing and managing the effects of chronic illnesses
- Coping with change: Understanding and adapting to life transitions (i.e. early childhood development, adolescence, menopause, etc.)
How does the government measure quality?
Congress mandated that the federal government produce an annual National Healthcare Quality Report (NCQA) and National Health Care Disparities Report to assess how well health care in the United States measures up in each of the following areas:
- Safe: Avoiding injuries to patients from the care that is intended to help them
- Effective: Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit
- Patient-Centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions
- Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care
- Efficient: Avoiding waste, including waste of equipment, supplies, ideas and energy
- Equitable: Providing care that does not vary in quality because of personal characteristics
What can you do to make sure you’re getting the top quality health care at the highest level of plan benefits?
Choose a primary care provider (PCP), such as a family physician, internist, pediatrician or general practitioner, as your personal doctor who participates in your plan’s network.
Your PCP will work with you to keep you healthy as well as coordinate your care when you are sick. This is especially important if you have more than one health problem and see different specialist doctors for different conditions.
Since you will be partnering with your PCP to ensure your good health, you need to be comfortable talking with him/her about your health care concerns and be confident that he/she will meet your needs and provide you with quality health care.
To find out which PCPs and other providers participate in your plan’s network, log in to My Plan where you‘ll be able to search for doctors who fit your criteria for location, specialty, gender and group or hospital affiliation.
If you have difficulty finding a doctor, contact Customer Service and a representative will be glad to assist you.
What you can do to choose a PCP?
The U.S. Agency for Healthcare Research and Quality (AHRQ) offers the following suggestions for selecting a personal doctor:
- Write down the things that are important to you about a doctor (e.g., training/experience, credentials, personal manner, accessibility, hospital affiliation, languages spoken, etc.).
- Get referrals from friends, family, other doctors, local medical society, health plans or hospitals and make a list of the doctors you want to know more about.
- Check the doctor's qualifications through trusted sources, such as those listed below.
- Call the doctor's office and ask basic questions, such as whether he/she is accepting new patients, office hours, other physicians in the practice, appointment availability, coverage for emergencies, etc.
- Once you have identified your top choice, make an appointment to meet the doctor to discuss your concerns and determine if you will be comfortable having him/her as your personal doctor.
Be sure to confirm your provider’s participation in your plan’s network to receive the highest level of benefit coverage
What to look for when choosing a doctor:
- Choosing a doctor, by the Agency for Healthcare Research and Quality (AHRQ)
- Physician Compare at Medicare.gov
- Administrators in Medicine DocFinder
Learn about the performance of physicians or physician groups:
- NCQA's Physician Recognition Programs (for best results, view in Mozilla Firefox or Google Chrome)
Choose quality hospitals
What you can do to choose a high-quality hospital
The U.S. Agency for Healthcare Research and Quality (AHRQ) suggests you ask the following questions when selecting a hospital:
- Does my health plan cover care at the hospital?
- Does my doctor have privileges at the hospital (is permitted to admit patients)?
- Does the hospital meet national quality standards?
- How does the hospital compare with others in my area?
- Does the hospital have experience with my condition?
- Has the hospital had success with my condition?
- How well does the hospital check and improve on its own quality of care?
Be sure to confirm your hospital’s participation in your plan’s network to receive the highest level of benefit coverage.
- Choosing a Hospital, by the Agency for Healthcare Research and Quality (AHRQ).
- The Leapfrog Group has information comparing hospitals on how well they are complying with recommended standards for protecting patient safety.
- The Joint Commission on Accreditation of Healthcare: "Quality Check" provides information on how a hospital measures up on clinical quality and compliance with patient safety standards.
- Hospital Compare is a tool for comparing hospitals on clinical quality that was developed by the Centers for Medicare and Medicaid Services. It uses some of the same measures used in the Joint Commission's "Quality Check."