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Quality Improvement Activities

The Health Plan has initiated several Quality Improvement Activities (QIAs) based on high volume or high-risk populations. Measurements methods for the following activities include survey, administrative (including claims and pharmacy data) and hybrid (including administrative data in conjunction with medical record data):

QIAs for Non-Clinical Service

  • Member Services Phone Call Statistics – Monitor statistics to evaluate job performance, customer satisfaction, and staffing issues – the focus is on decreasing the answering speed to 30 seconds or less.

  • Timeliness of Care – Improving Sanford Health Plan provider compliance with Plan accessibility standards.

QIAs for Clinical Care

  • Follow Up After Inpatient Mental Health – Monitor continuity of care and ambulatory follow up appointments after an inpatient stay for mental health.

  • Mental Health Medication Appropriateness - Increase appropriate utilization of mental health medications, including antidepressant compliance and lithium level checks within appropriate time frames.

  • Adolescent Health – Improve healthcare delivery to adolescents including increasing adolescent preventive visits and immunizations.

  • Migraines and Headaches – Improve the management of migraines and headaches.

  • Cancer Screening – Improve the rates of cancer screening (Includes breast cancer, cervical cancer, colorectal cancer and prostate cancer)

Disease Management Programs

Sanford Health Plan has developed a prospective disease-specific approach to the management of a member’s chronic medical conditions. The emphasis of these programs is disease prevention and wellness education for targeted members and physicians to improve the overall health, wellness and quality of the member’s life. The following is a brief description of the programs offered by Sanford Health Plan. More information on these programs may be obtained by calling the Plan at (800) 752-5863 or (605) 328-6800 or by email.
  • Diabetes – This program is designed for diabetic members to provide them with information about diabetes and their lifestyle. The information includes topics such as blood sugars, eating right, medications, exercise, recommended tests and more. These mailings occur on a quarterly basis.

  • Hypertension –This program educates our members on improving their hypertension management through prevention, lifestyle changes, appropriate therapies and treatment. The goal of the program is to assist our members with hypertension in achieving controlled blood pressure.

  • Congestive Heart Failure – This program is designed for members who have been diagnosed with CHF and provides them with information about the disease and their lifestyle. Disease information is sent quarterly and includes booklets from the Heart Failure Society of America in addition to references for more information on CHF.

  • Asthma – This program is designed for asthmatic members to provide them with information about asthma and their lifestyle. The information includes topics such as asthma triggers, asthma education, drug compliance, action plans, smoking cessation, an offer for a free peak flow meter and spacer, and more. Newsletters are provided on a quarterly basis.
    • Smoking Wellness Benefit added to give members an incentive to quit smoking.
  • Healthy Pregnancy – The Healthy Pregnancy Program focuses on education and awareness. The goal of the program is to identify markers of increased risk of pre-term delivery and to design interventions to improve pregnancy outcomes. These outcomes include a decreased frequency of deliveries at less than 37 weeks gestation and/or low birth weight babies.
In addition to the above quality improvement activities and disease management programs, Sanford Health Plan also provides various preventive health and educational activities and materials. The Member Messenger is mailed to all Health Plan members four times a year. Each issue is designed to offer wellness tips, disease management information and educational seminars to promote healthier living. The Plan also sends Birthday Card reminders to women regarding annual PAP tests, men for annual Prostate exams, and Welcome New Baby Cards for parents to know and document the recommended immunizations for their newborn infant. Preventive Health Guidelines are given to all new members of the Plan, published annually in the Member Messenger and are available on the Plan’s website.

The following are examples of diseases/conditions for which we have educational materials available to members at no cost, simply call the Health Plan at (800) 752-5863 or (605) 328-6800.
  • ADHD
  • Asthma
  • Cholesterol
  • Congestive Heart Failure
  • Diabetes
  • Health Pregnancy
  • Migraines
  • Keeping your Heart Healthy
  • Tobacco Cessation