Improving the quality of health care

Explore the efforts we’re taking to raise the standard of medical care.

Better health care 

Seeing results already

Current goals

We believe that by defining our goals in a clear and concise way, we can make major efforts in our quest to improve health care. Take a look at the ones we are most focused on achieving right now: 

• Deliver quality care and services that set community standards 
• Fulfill and exceed members’ expectations of care
• Give members care that is compassionate and effective 
• Make it easier to get care while staying within the financial means of members
  

Efforts and programs

Safety first

One of our specific goals is to create a more collaborative and secure healthcare environment. And to do this, we have begun to closely monitor clinical performance indicators, validate provider credentials, and track the coordination of care to ensure a safe delivery system. Through patient safety we can reduce medical errors, which will result in higher standards of care. 

Emphasizing preventive health

Part of improving the quality of care begins with members becoming familiar with preventive health guidelines. That’s why we’ve created checklists for women, men, teens, and children to help them plan effective care and treatment with their doctors.

• Prevention for women (PDF)
• Prevention for men (PDF)
• Prevention for adolescents (PDF)
• Prevention for children (PDF)

Making it easy on providers and members

Another effort of ours is to make sure our provider network is large enough for members to get healthcare services in a more convenient and easier way. To check and see if we are fulfilling our duties, we send out a yearly survey to providers in our network. Based on their answers and feedback, we can take steps to ensure a better experience for both doctors and members. 

Programs for managing health concerns

It’s important that our members have resources to help them understand how they can better manage their health. We’ve started programs for Disease Management and Case Management so that members can have helpful educational resources or talk to someone about their or a loved one’s condition. To learn more about these programs, email customer.service@sharp.com, fill out a referral form on your Sharp Health Plan online account, or call Customer Care at 1-855-995-5004

Quality Improvement Program Activities

Patient Safety
Sharp Health Plan’s advocates a collaborative approach to foster a culture of patient safety, reduce medical errors, and promote high quality care. Sharp Health Plan focuses on monitoring clinical performance indicators, provider credentialing and coordination of care to ensure a safe delivery system.

Preventive Health and Clinical Practice Guidelines
Preventive health guidelines are reviewed and updated using the most current and reasonable published medical evidence and the U.S. Preventive Services Task Force recommendations. The Preventive Health Services Medical Benefit Policy for all ages can be found here. Clinical practice guidelines encompass acute and chronic care relevant to Sharp Health Plan’s membership. Preventive and clinical practice guidelines are available to practitioners in the Sharp Health Plan Provider Operations Manual and can also be found on our Clinical Resources page.

Access and Availability
Sharp Health Plan monitors health care provider compliance with California laws regarding timely access to care. Sharp Health Plan is responsible for ensuring that the provider network is sufficient to ensure accessibility, availability and continuity of covered health care services. Sharp Health Plan is also responsible for ensuring members receive covered services in a timely manner. The Industry Collaborative Effort (ICE) Provider Satisfaction with Access Survey is completed annually for doctors in contracted medical groups. The Provider Access Appointment Availability Survey is also completed each year.

Health Management Programs
Sharp Health Plan monitors health care provider compliance with California laws regarding timely access to care. Sharp Health Plan is responsible for ensuring that the provider network is sufficient to ensure accessibility, availability and continuity of covered health care services. Sharp Health Plan is also responsible for ensuring members receive covered services in a timely manner. The Industry Collaborative Effort (ICE) Provider Satisfaction with Access Survey is completed annually for doctors in contracted medical groups. The Provider Access Appointment Availability Survey is also completed each year. Health Management Programs Sharp Health Plan’s Disease Management and Case Management programs are available to meet the health care needs of members with complex health conditions or diseases through communication, education and resources. If you would like more information about our Disease Management and Case Management Programs, please contact Customer Care at (858)499-8300, 1-800-359-2022 or customer.service@sharp.com.

Tracking performance

What is Healthcare Effectiveness Data and Information Set (HEDIS®)?

HEDIS is a commonly-used set of health care performance measures in the U.S. It measures 75 aspects of care in the following categories:

• Effectiveness of care 
• Access/availability of care
• Use of services 
• Cost of care

With the measurement results from HEDIS, the health care field can find areas that need improvement and take steps for making the quality of care better for members and staff.  

What is Consumer Assessment of Healthcare Providers and Systems (CAHPS®)?